What to know about diabetic foot ulcers

Change in a diabetic foot ulcer comes slowly, which is why the wound is measured at regular visits. In the early weeks of care, clinicians look for the wound to become smaller and shallower and for healthy red tissue to fill in the base. A wound that stays the same size visit after visit is a signal to look for a cause instead of simply waiting longer. Setbacks are common. A few days in the wrong shoes, or a stretch without the protective device, can undo progress. Once the skin closes, the area stays weaker than the skin around it, and ulcers often return at or near the same spot. The months after closure call for protective footwear and continued foot checks.

What the treating clinician looks at

Part of building a plan is finding out what a person can realistically do. Expect the treating clinician to ask questions such as:

  • How far do you walk in a day, and on what surfaces?
  • Can you see and reach the bottoms of your feet?
  • Who is available to help with dressings?
  • Have you had an ulcer, foot surgery or an amputation before?
  • What has already been tried on this wound?

The answers shape the choice of offloading device and the dressing schedule. A plan that fits daily life is one a person can keep following, and reassessment at each visit shows whether it is working.

Local context: Florissant

Many people in Florissant have lived in the same house for decades and intend to stay. A diabetic foot ulcer tests that plan. Older homes tend to have steps at every entrance, laundry in the basement and a tub to climb into, each one a moment of full weight on the wounded foot. During home visits the treating clinician can point out practical changes, and Gateway follows up on any equipment ordered. If care needs outgrow the house, skilled nursing and rehabilitation facilities are close by, and you can ask us about continuing wound visits there.

Florissant is one of the largest cities in North County, with a historic Old Town at its heart and decades of subdivisions spreading out from it. Lindbergh Boulevard cuts across the city, and New Halls Ferry Road links it to its neighbors. A great many of its homes are single-story ranches, bought by young families years ago and still occupied by the same owners. That makes Florissant a natural place for aging at home, and it makes home-based wound care and primary care especially useful as those owners need more medical attention.

At home between visits

Most of the time a foot ulcer spends healing falls between visits, so the plan for those days matters. The treating clinician will spell out how often the dressing is changed, who changes it, how much walking is allowed and what goes on the foot indoors, including short trips to the bathroom at night. Keeping the offloading boot or shoe beside the bed makes those trips easier to do correctly. A simple daily routine helps: look at both feet, check whether drainage has soaked through the dressing, and write down anything new. If a question comes up, call Gateway and we will pass it to the treating clinician.

In a facility

Assisted living poses a particular challenge for diabetic foot ulcers. Residents are fairly independent, staff may not be permitted to change wound dressings, and a person can walk on a sore foot for days before anyone sees it. When Gateway arranges visits in an assisted living community, we ask who handles dressings between visits: facility staff, a home health nurse or family. The treating clinician shapes the plan around that answer. We also let the community’s nurse or wellness director know what to watch for, such as drainage on socks or a resident who has stopped wearing the prescribed shoe.

Signs to tell the clinician about

Some changes point to trouble with blood flow or to tissue that is dying. Report these to the treating clinician without waiting for the next visit:

  • Black, gray or dark purple skin on a toe, the heel or the wound edge
  • A wound that looks deeper, or one where bone or tendon can be seen
  • A toe that has become cold or discolored
  • Foot pain at rest or at night that eases when the leg hangs down

Call 911 if a foot or leg suddenly turns cold, pale or blue, or for chest pain, severe bleeding or loss of consciousness.

Why primary care matters here

Being told to keep weight off a foot changes daily life. A boot or cast can alter balance, raise the chance of a fall and make it harder to reach appointments, the pharmacy or the kitchen. Primary care looks at that wider picture: fall risk, vision, mood, sleep, vaccinations, and whether a walker, wheelchair or shower chair would help. For people who are homebound or have lost touch with a regular doctor, Gateway can arrange primary care visits alongside wound visits. With one coordinating point for both, it is less likely that the foot gets attention while the rest of a person’s health goes unwatched.

Primary care at home in Florissant →

How to get started in Florissant

People asking about diabetic foot ulcer care in Florissant usually want to know what the first visit involves. Before it, Gateway collects the records the treating clinician asks for and confirms the time and place with you. During it, the clinician looks at the wound and the skin around it, measures it, asks about your health and medications and explains what they recommend. Afterward, the orders go to whoever does the daily care, supplies are requested and a follow-up is planned. Our guide to how mobile wound care visits work has more. To begin, call 314-325-0126. Whether a visit can be arranged is confirmed for your location.

Florissant residents usually go to Christian Hospital in North County, east along Interstate 270, or to SSM Health DePaul Hospital in Bridgeton to the southwest. Gateway is independent of both. For discharge planners, the process is short: fax the referral, wound orders and face sheet, and note whether the patient is going home or to a facility. For families, call and tell us the hospital and the going-home date. Gateway requests the records, checks availability in 63031, 63033 or 63034, and arranges follow-up with a treating clinician.

  • County: St. Louis County, Missouri
  • ZIP codes: 63031, 63033, 63034
  • Nearby hospitals: Christian Hospital in North County; SSM Health DePaul Hospital in Bridgeton (not affiliated with Gateway)
  • Nearby communities: Hazelwood, Ferguson, North County, Bridgeton
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in Florissant

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

Common questions

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

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.

How often will the clinician visit for a diabetic foot ulcer?

The treating clinician sets the schedule based on how severe the wound is, the dressing plan and who is helping between visits. The frequency often changes as the ulcer improves or if a problem appears. Gateway does not promise a specific timetable, and visit availability is confirmed by location and care setting. If something changes before the next visit, call us so the clinician can decide what to do.

What is offloading, and why does everyone keep bringing it up?

Offloading means taking pressure off the part of the foot where the ulcer is. It may involve a cast, a removable boot, a special shoe, padding or limits on walking. Clinicians stress it because skin cannot rebuild while it is pressed against the ground with every step. The treating clinician chooses the method, and it helps only during the hours it is actually worn.

Florissant has three ZIP codes. Which ones can request care through Gateway?

All three. People in 63031, 63033 and 63034 can ask Gateway to arrange wound care or primary care at home or in a facility. These ZIP codes also take in some areas outside the city limits with a Florissant mailing address, and those are welcome too. Availability is confirmed for the exact address and the care setting, so please have the street address ready when you call.

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.