Understanding venous leg ulcers

Leg veins have to push blood uphill. They rely on two helpers: one-way valves inside the vein, and the calf muscle, which squeezes the veins with every step. When valves wear out or are damaged by an old blood clot, blood slips backward and collects near the ankle. Pressure in those veins stays high whenever you sit or stand.

That pressure forces fluid and blood cells out into the tissue, which swells, stiffens and receives less oxygen and nourishment than healthy skin. Skin in that state is easy to injure and slow to mend. A scrape from a walker, an insect bite or scratching an itchy patch can be enough to start an ulcer.

What the treating clinician looks at

The history shapes a venous ulcer plan as much as the exam does. The treating clinician asks how long the ulcer has been open, whether this leg has ulcerated before, and whether you have had a blood clot, a vein procedure, leg surgery or an injury. Allergies are reviewed, along with any skin reaction to past dressings, tapes or wraps, so the same products are not ordered again.

The clinician also asks what you have already tried and what happened. An ulcer that does not look or behave like a typical venous wound, or one that fails to respond, may lead to more tests or a referral to a vascular or skin specialist.

Venous leg ulcer care in Ferguson

Many people with venous leg ulcers in Ferguson have lived in the same house for decades, and some later move to a senior living community or skilled nursing facility a short drive away. The ulcer plan should move with them. Gateway keeps track of the measurements, compression orders and supply details, so when someone goes from home to a rehabilitation stay and back, the receiving nurses know what was on the leg and why. Because partner clinicians see patients in both homes and facilities, the plan can often continue without starting the assessment over.

In Ferguson you will see older frame and brick houses near the center of town, ranch homes in later subdivisions, and apartment complexes along the busier roads. Some households have three generations under one roof, and some older adults live alone. Skilled nursing, rehabilitation and assisted living facilities serve Ferguson and the neighboring cities. Gateway arranges partner clinician visits in homes, apartments and facilities alike. We ask who helps the patient day to day, because the treating clinician’s instructions need to reach that person, whether a daughter, a home aide or a charge nurse.

At home between visits

Family caregivers often carry part of the work for a venous leg ulcer at home. Depending on the orders, that might mean helping with a stocking or adjustable garment, changing an outer dressing, propping the legs at rest, or watching the toes and skin for changes. No one should have to guess. The treating clinician can show a caregiver which tasks are theirs and which to leave alone, and Gateway can request visit times when the caregiver is able to be there. If the caregiver works, travels or lives elsewhere, tell us, and with your permission we will keep them informed by phone.

In a facility

A short rehabilitation stay after surgery or a hospital admission can be a turning point for a venous leg ulcer. Legs often swell more after days in bed and long hours in a wheelchair with the feet down. Therapy sessions, on the other hand, rebuild the walking and ankle movement that help veins work. Partner clinicians see patients on site and coordinate with nursing and therapy on details such as wrap changes around therapy times and footwear that fits over compression. Before discharge, Gateway helps line up continued visits and supplies at home so the plan does not lapse during the move.

Changes to report

Some changes point beyond the ulcer to the rest of the body. Tell the treating clinician promptly about:

  • New swelling, pain or tenderness in one calf or thigh
  • Swelling that rises quickly in both legs
  • Rapid weight gain over a few days
  • Needing more pillows to breathe comfortably at night
  • A fall or a new injury to the leg

Call 911 right away for sudden shortness of breath, chest pain, coughing up blood, or a racing heartbeat with lightheadedness. These can be signs of a blood clot in the lungs or a heart problem, and they should not wait for a scheduled visit.

How primary care fits in

A draining venous ulcer asks a lot of the body. Protein is lost in wound fluid, and healing skin needs steady calories, protein and fluids to rebuild. Older adults with a poor appetite, dental problems or a tight food budget can fall behind without anyone noticing. A primary care clinician can check weight trends and lab work, look for anemia, and review diabetes control, since high blood sugar slows repair and raises infection risk. Body weight matters as well, because extra weight adds pressure to leg veins. None of this replaces wound care. It supports it, which is why Gateway can arrange both.

Primary care at home in Ferguson →

How to get started in Ferguson

Setting up venous leg 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 venous leg ulcers, or see everything Gateway arranges on the mobile wound care in Ferguson page.

Common questions

My mother lives in a nursing home in Ferguson. Can Gateway arrange venous ulcer care there?

Often, yes. Partner clinicians see residents in skilled nursing, assisted living, memory care and rehabilitation settings, working alongside the facility’s nurses and the attending physician. Start by telling us the facility’s name, or ask its nursing staff to contact Gateway. We confirm whether visits are available at that location and what the facility needs in order to begin.

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 should I have ready before the first visit?

A few things help: a list of your medications and allergies, the names of your other clinicians, any recent hospital or clinic records about the leg, and results of circulation tests if you have had them. Keep the dressings and wraps you are using now so the clinician can see them. If a family member helps with your care, ask them to be present or available by phone.

Can I ask about Medicaid or a Medicare Advantage plan for care in Ferguson?

Yes, please ask. People in Ferguson can ask about Medicare, Medicare Advantage, Medicaid and commercial plans. Whether a visit or supply is a benefit under your plan depends on the treating provider, the specific plan and the care that is needed, so we cannot answer that for you in advance. Have the insurance card nearby when you call, and we will explain what the treating practice needs to check.

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.