Understanding diabetic foot ulcers

Most diabetic foot ulcers begin with pressure or friction that the person never feels. Years of high blood sugar can damage the nerves that carry pain and temperature signals from the feet, so a pebble in a shoe, a tight seam or hot pavement does its harm unnoticed. The same nerve damage can dry the skin until it cracks, and it can weaken the small muscles of the foot so the toes curl and bones press down in new places. Callus builds over those pressure points, and the tissue underneath breaks down. When narrowed arteries also limit the blood supply, the skin is less able to repair small injuries, and a minor break becomes an open wound.

What an assessment covers

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: Hazelwood

Many people in Hazelwood 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.

Hazelwood stretches along Interstate 270 in North County, an irregularly shaped city bordered by Florissant, Bridgeton and the land around Lambert airport. Warehouses and business parks share the map with residential streets, and Lindbergh Boulevard ties the two together. People here are used to getting on the highway for almost everything. That works until a health problem makes travel difficult. Wound care and primary care brought to a Hazelwood home or care facility let treatment go on without a highway trip each time, which matters most for patients who depend on someone else to drive.

At home between visits

Family caregivers do much of the day-to-day work when a diabetic foot ulcer is cared for at home. A spouse or adult child may be the only person who can see the sole of the foot, hold a mirror or notice a damp sock. The treating clinician decides which dressing tasks a caregiver can take on and explains what is expected. Caregivers also help by keeping the offloading device within reach, clearing clutter from walking paths, and writing down blood sugar readings and questions for the next visit. If the tasks become more than your household can manage, tell us and we will raise it with the clinician.

For residents of nursing and senior living communities

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

Infection is the change clinicians most want to hear about early, and in a numb foot it may not hurt. Contact the treating clinician promptly if you notice:

  • Redness that is spreading, or a red streak moving up the foot or leg
  • Skin around the ulcer that feels warmer than the other foot
  • Thicker, cloudy or foul-smelling drainage
  • New swelling of the foot or ankle
  • Fever, chills or feeling generally unwell

Call 911 for confusion, a racing heart, trouble breathing or fainting. Gateway is not an emergency service.

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 Hazelwood →

Getting care arranged in Hazelwood

If you have been managing a wound mostly on your own and are looking for diabetic foot ulcer care in Hazelwood, you can call Gateway yourself at 314-325-0126. Tell us what the wound looks like now, what the last clinician said about it and what is getting harder to manage. It helps to know the patient’s insurance and the names of the doctors involved, but do not wait until you have everything. We check whether a partner clinician can see the patient at home or in their facility, and we tell you what we find. The treating clinician takes it from there, and you stay part of the conversation.

SSM Health DePaul Hospital in Bridgeton is the closest hospital for most of Hazelwood, and Christian Hospital in North County is a short drive east on Interstate 270. Gateway is not affiliated with either one. Patients sent home with a surgical wound, a pressure injury or a leg ulcer need someone to follow it. Discharge planners can fax a referral with orders and demographics. Family members can call with the hospital name and discharge date. Gateway requests the records, confirms the Hazelwood address, and arranges the follow-up visit with a treating clinician.

  • County: St. Louis County, Missouri
  • ZIP codes: 63042
  • Nearby hospitals: SSM Health DePaul Hospital in Bridgeton; Christian Hospital in North County (not affiliated with Gateway)
  • Nearby communities: Florissant, Bridgeton, Ferguson, Maryland Heights, North County
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Other conditions and nearby communities

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

Common questions

Can a wound care clinician come to a home in Hazelwood for a diabetic foot ulcer?

In many cases, yes. Gateway arranges home visits with partner clinicians across the region, and we confirm availability for your address and care setting when you call. You do not need a referral to ask. If you have a podiatrist or primary care doctor, have the office name ready so we can request records before the first visit.

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.

What is Charcot foot, and is it related to foot ulcers?

Charcot foot is a condition in which the bones and joints of a numb foot weaken and shift, sometimes after a minor injury that was never felt. The foot may become red, warm and swollen with no open wound. As its shape changes, new pressure points form and ulcers can follow. It needs prompt evaluation, so report a suddenly swollen, warm foot to a clinician even if the skin is intact.

Hazelwood is spread out along Interstate 270. Is every part of the city included?

You can request care from any part of Hazelwood, whether you live near Lindbergh Boulevard, close to the airport or toward the Florissant line. Because the city is so spread out, the partner clinicians available may differ from one end to the other. Give us the street address and we will confirm availability for that location and care setting.

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.