About venous leg ulcers
A venous leg ulcer is a break in the skin of the lower leg that stays open because the veins beneath it are not doing their job. Most appear between mid-calf and ankle, commonly on the inner side near the ankle bone. They are usually shallow, with an irregular outline and a moist red or yellowish base. Drainage can be heavy enough to soak through dressings and socks.
The skin nearby tells part of the story. It may look stained brown or purple, feel tight, hard or itchy, and swell more as the day goes on. Pain varies. Some people feel a dull ache that eases when the leg is raised, and others feel very little.
What the treating clinician looks at
A plan for a venous leg ulcer has to work on ordinary days, so the treating clinician looks at how you live with the leg. Can you bend far enough to reach your foot? Do your hands have the grip to pull on a stocking? Who is in the house to help, and how often? What shoes fit over a wrap?
The answers guide the kind of compression that is ordered. Layered wraps applied by a clinician suit some people. An adjustable garment that a caregiver can manage suits others. A plan that fits your routine is more likely to stay on the leg, and compression only helps while it is worn.
Arranging this care in Downtown St. Louis
City housing shapes venous ulcer care in Downtown St. Louis. A third-floor walk-up means the leg hangs down and works hard on every trip, and a bulky multi-layer wrap may not fit the shoes you trust on stairs. Tell us about steps, elevators, entry buzzers and where a visiting clinician can park, so the visit is not delayed at the door. Dressing and compression supplies sent to an apartment building can sit in a lobby or mailroom, so we ask who can receive packages. The clinician can also suggest where in a small apartment you can raise your legs comfortably.
Homes in Downtown St. Louis are almost all multi-unit: converted lofts, high-rise apartment towers, senior apartment buildings and a smaller number of condominiums. Skilled nursing and rehabilitation centers lie a short distance away in neighboring parts of the city. Gateway arranges partner clinician visits to all of these settings. Before a downtown visit we confirm how to get past the front door, whether a building manager needs notice, and where the clinician can leave a car. We also ask where supply deliveries should go, since packages are handled differently in each building.
When care happens at home
Most of the healing in a venous leg ulcer happens between visits. The treating clinician leaves instructions for those days: how long a wrap stays on, how to keep it dry, when to put your feet up, and what to do if a wrap slides down. If a wrap comes off early or drainage soaks through, call instead of waiting for the next scheduled visit. Gateway takes those calls, relays the question to the clinician and arranges whatever follows, such as a supply shipment or an earlier visit when one is available. Writing down questions as they come up makes each visit more useful.
For residents of nursing and senior living communities
In a skilled nursing facility, venous leg ulcer care is shared work. The partner clinician sees the resident on site, assesses the ulcer and the circulation, and writes or recommends orders in line with the facility’s process. Nursing staff carry out dressing changes and compression between visits and document what they see. Gateway keeps the two connected by scheduling rounds with the facility, sending visit notes and following up on open questions. The attending physician stays informed and remains in charge of the resident’s overall medical care, including the heart, kidney and medication issues that affect leg swelling.
Changes to report
Compression should feel snug and supportive, not painful. Contact the treating clinician promptly if any of these occur while a wrap or garment is on:
- Toes that look pale, bluish or darker than usual, or feel cold
- Numbness, tingling or pins and needles in the foot
- New or sharper pain under the wrap, particularly over the shin or ankle
- A wrap that has rolled, slid down or formed a tight band
- Swelling that bulges above or below the wrap
Follow the instructions you were given for these situations, including whether to take the wrap off. Call 911 if the foot or leg suddenly turns cold, pale and severely painful.
Primary care and overall health
The calf muscle acts as a pump for the leg veins, and it only works when the ankle moves. Arthritis, nerve damage, an old injury, pain from the ulcer itself or fear of falling can shrink a person’s walking to a few steps a day. A primary care clinician can look at what is limiting movement, manage pain, review fall risk and order physical therapy or equipment when appropriate. Sleep is part of this too. People who sleep upright in a recliner because of breathing trouble or back pain keep their legs down all night, and the reason behind that habit needs a medical answer.
Arranging venous leg ulcer care in Downtown St. Louis
To arrange venous leg ulcer care in Downtown St. Louis, call Gateway at 314-325-0126. Patients, family members and caregivers can call directly, and a referral is not required. We will ask where the patient lives, what has been done for the wound so far and which clinicians are involved. Gateway then confirms whether a partner clinician is available for that address and care setting, requests the relevant records and schedules the visit. At that visit the treating clinician examines the wound and decides on the plan. Our job from then on is the coordination: orders, supplies, follow-up visits and keeping the care team informed.
The two hospitals people in Downtown St. Louis use most are SSM Health Saint Louis University Hospital, a couple of miles southwest on Grand Boulevard, and Barnes-Jewish Hospital in the Central West End. Gateway is not affiliated with either. If you are being discharged to a downtown apartment, ask your case manager to fax a referral, or call us yourself. Gateway requests the discharge records and wound orders, confirms building access, and arranges follow-up with a treating clinician. Discharge planners can help by noting the unit number and a contact who will answer the door.
- County: City of St. Louis, Missouri (an independent city)
- ZIP codes: 63101, 63102, 63103
- Nearby hospitals: SSM Health Saint Louis University Hospital; Barnes-Jewish Hospital (not affiliated with Gateway)
- Nearby communities: St. Louis City, Central West End, North St. Louis, South St. Louis
- Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation
More wound care in Downtown St. Louis
Read the full guide to venous leg ulcers, or see everything Gateway arranges on the mobile wound care in Downtown St. Louis page.
- Diabetic foot ulcers
- Pressure injuries and bed sores
- Arterial and mixed wounds
- Non-healing wounds
- Post-surgical wounds
- Reopened (dehisced) surgical wounds
- Surgical site infections
- Skin tears and traumatic wounds
- Wounds with lymphedema
- Skin graft aftercare
- Wound VAC (NPWT) follow-up
- Venous leg ulcer care in the City of St. Louis
- Venous leg ulcer care in the Central West End
- Venous leg ulcer care in North St. Louis
- Venous leg ulcer care in South St. Louis
Common questions
Who arranges long-term compression garments for patients in Downtown St. Louis once an ulcer has closed?
The treating clinician or your primary care clinician decides whether you need ongoing compression and at what strength. Garments usually require measuring, and they wear out and need replacing. Gateway can coordinate the order, the fitting and reminders for replacement, and can arrange primary care follow-up if you do not have a regular clinician. Payment for garments depends on your plan.
Could a leg ulcer that will not heal be something other than a venous ulcer?
Yes. Poor arterial circulation, diabetes, pressure, inflammatory conditions, certain infections and, rarely, skin cancer can all cause leg wounds that resemble venous ulcers. That is one reason the clinician reassesses an ulcer that is not responding as expected. Further circulation testing, lab work, a tissue sample or a specialist referral may be ordered. Raise the question directly if you are worried.
What is the difference between a venous ulcer and an arterial ulcer?
Venous ulcers come from blood pooling in the leg. They tend to be shallow, wet and located near the ankle on a swollen leg. Arterial ulcers come from too little blood reaching the tissue and are often on the toes, foot or shin, with a dry base and pain that worsens when the leg is raised. Some people have both. Telling them apart takes a clinical exam and circulation testing.
I live in Downtown St. Louis without a car. Can wound care come to my apartment?
Yes, that is the purpose of the service. Gateway arranges for a partner clinician to see you in your apartment, so you do not need a ride for the visit itself. If the treating clinician orders a test or appointment that must happen elsewhere, we can help coordinate transportation arrangements. Availability for your building is confirmed when you call 314-325-0126.
General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.