Understanding venous leg ulcers
Venous leg ulcers are more common in older adults, but age is not the only factor. People who have had a blood clot in a leg vein, varicose veins, leg surgery or a serious leg injury carry more risk. So do people who stand or sit for most of the day, people with a higher body weight, and women who have had several pregnancies. A family history of vein trouble is common.
Anything that keeps the ankle from bending, such as arthritis, an old fracture or weakness after a stroke, also plays a part. Many people notice years of warning signs first: ankles that swell by evening, legs that feel heavy, and skin that slowly darkens above the ankle.
How the care plan is built
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.
Arranging this care in Jefferson County
For patients in Jefferson County, running out of supplies is a bigger problem than it is closer to the city. The right absorbent dressing or wrap layer is rarely on a local pharmacy shelf, and a draining ulcer covered with a poor substitute can quickly damage the surrounding skin. Gateway plans supply orders ahead of need and asks whether an order can include a reserve for weeks when weather delays a delivery or a visit. We also make sure you know whom to call between visits, and which changes mean going to the nearest emergency department.
Jefferson County has subdivisions and apartments in Arnold and Imperial, older homes in the river towns, manufactured homes, lake communities, and houses on acreage reached by gravel roads. Skilled nursing, rehabilitation and assisted living facilities are found mainly in the larger towns. Gateway arranges partner clinician visits in private homes and in facilities throughout the county. For homes, we collect directions and access notes. For facilities, we work with the nursing team so that wound orders, supply deliveries and visit days are understood by every shift.
At home between visits
At a home visit, the partner clinician removes the old wrap and dressing, checks the skin, measures the ulcer and the swelling, and reapplies what was ordered. Seeing the home helps. The clinician can look at the chair where you spend most of the day, whether a footstool or recliner raises your legs, and how far you walk to the bathroom or kitchen. Details like these often explain why a leg is more swollen on some days than others. Gateway schedules the visits, confirms the day with you or a family member, and passes the clinician’s notes and orders to the others involved in your care.
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
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.
How primary care fits in
Venous disease is a long-term condition, and the ulcer is one episode in it. Once the skin closes, someone needs to keep watching the legs, renew orders for compression garments as they wear out, and decide whether a referral to a vein specialist makes sense. That ongoing role usually belongs to primary care. A primary care clinician also weighs how other treatments affect the leg, such as blood thinners after a clot or a change in blood pressure medicine. For patients without a regular clinician, or who can no longer get to an office, Gateway can arrange primary care visits alongside wound care so follow-up continues.
Getting care arranged in Jefferson County
If you have been managing a wound mostly on your own and are looking for venous leg ulcer care in Jefferson County, 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.
Where a Jefferson County resident is hospitalized usually depends on where they live. In the south and center it tends to be Mercy Hospital Jefferson in Festus. In the north, many go to Mercy Hospital South or SSM Health St. Clare Hospital in Fenton, both just over the county line. Gateway is not affiliated with these hospitals. A discharge planner at any of them can fax a referral, and families can call us. We request records, confirm the patient’s Jefferson County address and care setting, and arrange a follow-up visit with a treating clinician.
- County: Jefferson County, Missouri
- ZIP codes: 63010, 63028, 63019, 63052, 63012, 63050, 63020, 63049, 63051
- Nearby hospitals: Mercy Hospital Jefferson in Festus; Mercy Hospital South; SSM Health St. Clare Hospital in Fenton (not affiliated with Gateway)
- Nearby communities: Arnold, Festus and Crystal City, Imperial, Fenton, Oakville
- Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation
More wound care in Jefferson County
Read the full guide to venous leg ulcers, or see everything Gateway arranges on the mobile wound care in Jefferson County 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 Arnold
- Venous leg ulcer care in Festus and Crystal City
- Venous leg ulcer care in Oakville
Common questions
Can a clinician come to a home in Jefferson County to care for a venous leg ulcer?
In many cases, yes. Gateway arranges visits from partner clinicians to private homes, and we confirm availability for your address and care setting when you call. The clinician assesses the leg, writes the orders and returns on the schedule they set. Call 314-325-0126 to ask. For anything life-threatening, call 911 instead.
Is it normal for a venous leg ulcer to hurt?
Many do, though the amount of pain varies widely. Aching and heaviness that ease with elevation are common. Pain at dressing changes can sometimes be reduced with a different dressing or approach, so mention it. Pain that suddenly gets worse, or pain with spreading redness, fever or cold, discolored toes, should be reported to the treating clinician promptly and not waited out.
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.
How do hills, gravel roads and winter weather affect home visits in Jefferson County?
They are part of planning here. Tell us if your road is steep, unpaved or hard to pass after rain or snow, and whether there is a place to turn around. In bad weather a visit may need to be moved for safety, and we will contact you to reschedule. Ask the treating clinician what to watch for and what to do if a visit is delayed.
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.