Understanding diabetic foot ulcers

A diabetic foot ulcer is an open wound on the foot of a person with diabetes, deep enough that the full thickness of the skin is gone. Common places are the ball of the foot, the tips and tops of the toes, the heel and the outer edge of the foot. It can look like a shallow crater ringed with thick callus, or like a small hole that runs deeper than its opening suggests. Clinicians describe an ulcer by its location, size and depth, the tissue in its base, and whether infection or poor blood flow is present. Those descriptions guide what gets ordered, and they give everyone involved a shared way to tell whether the wound is improving.

What the treating clinician looks at

At the first visit the treating clinician usually measures the length, width and depth of the ulcer and notes what the base looks like: pink or red tissue, yellow slough, dark dead tissue, or structures that should not be visible. The edges get attention too, because a thick rim of callus or skin that has been undermined changes the plan. The amount, color and odor of any drainage are recorded. The clinician may also check whether the wound reaches toward bone, since that raises the question of bone infection and may lead to imaging or lab work. These findings become the baseline that later visits are measured against.

Diabetic foot ulcer care in Ferguson

In Ferguson, a person with a foot ulcer is often a long-time homeowner whose spouse or neighbor helps out, and whose podiatrist and primary care doctor are close by. That existing circle is an asset. Gateway sends updates to each office after wound visits, so the people who know the patient are not working from old information. Seniors who have moved to an independent or assisted living community nearby can be seen there too. In either setting, show the clinician the worn house shoes by the door, because comfortable old footwear is a frequent source of rubbing.

Ferguson is a North County city of older, tree-shaded neighborhoods set between Interstate 270 to the north and Interstate 70 to the south. Florissant Road runs through its small downtown, and West Florissant Avenue carries traffic along the east side. Most streets are lined with modest houses, many owned by the same families for a generation or more. When someone in one of those homes develops a wound that will not close, or comes back from the hospital weaker than before, care delivered at home or in a nearby facility keeps treatment from depending on a ride.

Care at home

When dressings need changing more often than visits occur, the treating clinician may order home health nursing, and Gateway helps set that up with an agency that serves your area. The agency nurse follows the wound orders and reports changes back. Supplies are the other piece. Dressings, wraps and offloading devices are ordered by the clinician, and we track each order so the right sizes arrive before the current stock runs out. Store supplies together in one clean, dry place, and tell us early if a box is running low or if the boot or shoe no longer fits well.

For residents of nursing and senior living communities

A resident with dementia may not remember having a foot wound, may pull off a dressing, or may refuse a boot that feels strange. Memory care teams know these patterns, and the treating clinician plans with them. That can mean choosing dressings that stay in place, timing care for a calmer part of the day, and asking staff which footwear the resident will keep on. Because the resident often cannot report pain or changes, staff observations carry extra weight. Gateway relays those observations to the clinician between visits and helps keep family members or legal decision-makers informed about the plan.

What to report and when to call 911

Whoever changes the dressing is well placed to spot trouble. Let the treating clinician know if you see any of the following:

  • Drainage soaking through sooner than it used to
  • The wound measuring larger, or new openings nearby
  • Skin around the wound turning white, soggy or raw
  • A new blister or rubbed area where the boot, cast or shoe touches
  • Fresh blood on a dressing that used to come off clean

Bleeding that will not stop with firm pressure, sudden weakness, slurred speech or difficulty breathing are reasons to call 911, not to wait for a call back.

How primary care fits in

Blood sugar and wound healing are closely tied. When glucose runs high over time, the cells that fight infection and rebuild tissue work less well, and an infected wound can in turn push readings higher. Wound visits do not manage diabetes medications. That belongs to the primary care clinician or endocrinologist, who may review recent readings, lab results and the current regimen while the ulcer is being cared for. Gateway helps the two sides share information, so the clinician managing diabetes knows there is an open wound and the wound clinician knows how glucose has been running.

Primary care at home in Ferguson →

Arranging diabetic foot ulcer care in Ferguson

Setting up diabetic foot ulcer care for someone in Ferguson usually goes in this order:

  1. You call 314-325-0126 or send the request care form, which asks only for a name and phone number.
  2. Gateway talks with you about the wound, the address and the insurance.
  3. We confirm availability for that location and gather records for the treating clinician.
  4. The clinician visits, assesses the wound and writes the orders.
  5. We follow up on supplies, the next visit and communication with your other clinicians.

You do not need a confirmed diagnosis to start.

Christian Hospital in North County and SSM Health DePaul Hospital in Bridgeton are where people from Ferguson are most often admitted. Neither is affiliated with Gateway. The step from hospital to home is where wound care tends to get lost: new dressings, new medications, and no one assigned to look at the wound next week. A discharge planner can prevent that by faxing a referral before the patient leaves. Families can call us with the same information. Gateway obtains the records and arranges follow-up with a treating clinician at the Ferguson address.

  • County: St. Louis County, Missouri
  • ZIP codes: 63135
  • Nearby hospitals: Christian Hospital in North County; SSM Health DePaul Hospital in Bridgeton (not affiliated with Gateway)
  • Nearby communities: Florissant, Hazelwood, North County, North St. Louis, Bridgeton
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

More wound care in Ferguson

Read the full guide to diabetic foot ulcers, or see everything Gateway arranges on the mobile wound care in Ferguson page.

Common questions

Does Medicare or Medicaid pay for diabetic foot ulcer care in Ferguson?

We cannot say in advance. Coverage depends on the treating provider, your specific plan and the care that is ordered, and the rules for visits, dressings and offloading devices can differ. You can ask us about Medicare, Medicare Advantage, Medicaid and commercial plans. Gateway checks what it can with the provider and the plan before the first visit and tells you what we find.

What shoes should I wear once the ulcer has closed?

Footwear after closure is a medical decision more than a shopping one. Many people are measured for shoes and inserts made for diabetic feet, usually through a podiatrist or a footwear specialist on a clinician’s order. Going back to the shoes worn before the ulcer is a common reason wounds return. Ask the treating clinician when and how to move out of the offloading device.

What should I have ready for the first visit?

Gather a current medication list, recent blood sugar readings if you keep them, and any hospital or clinic papers about the foot. Set out the shoes, inserts, boot or other devices you use, along with the dressing supplies you have on hand. Write down the names of your doctors and your questions. A chair with good light and a place to prop the foot make the exam easier.

My grandmother in Ferguson has no ride to appointments. How can Gateway help?

Gateway can arrange for a partner clinician to visit her at home in Ferguson, so no ride is needed for wound care or primary care visits. If the treating clinician orders something that requires travel, such as imaging or a specialist appointment, we can coordinate transportation arrangements and the appointment together. Call 314-325-0126, tell us her address and phone number, and we will check what is available.

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.