Diabetic foot ulcer care in the Metro East.

What to know about diabetic foot ulcers

Foot ulcers are more likely in people who have had diabetes for many years, especially once feeling in the feet has faded. Anyone who has had an ulcer or an amputation before is at higher risk, because healed skin stays fragile and the pressure pattern behind the first wound is often still there. Other things that raise risk include poor circulation in the legs, kidney disease, changes in foot shape such as hammertoes, bunions or a collapsed arch, vision loss that makes foot checks hard, and trouble bending to reach the feet. People who live alone, or who cannot easily get properly fitted shoes, are more exposed too. None of this makes an ulcer certain. It tells clinicians whose feet to watch closely.

What an assessment covers

Clinicians grade diabetic foot ulcers by severity, and the grade shapes what follows. A shallow wound with good blood flow and no infection can often be managed with visits at home or in a facility. A wound with spreading infection, exposed bone or tendon, or poor circulation may need a hospital, a surgeon or a vascular specialist, and the treating clinician will tell you if that is the case. Between those two ends, the clinician weighs what can be done on site against what calls for imaging, lab work or a specialist’s opinion. Gateway’s part is to move the resulting orders and referrals along and to let you know who should be calling you.

Local context: Metro East

People in the Metro East with a diabetic foot ulcer often split their care between two states: a primary care office and hospital in Illinois, and a vascular surgeon or foot specialist in St. Louis. Records do not always follow across the river. Gateway requests them from both sides so the treating clinician can see the circulation studies, cultures and imaging already done. If a specialist visit in Missouri is ordered, we first check whether your plan and that provider work together, then help with transportation across the bridge so the foot is not walked on more than necessary.

The Metro East is the Illinois side of the St. Louis region: St. Clair, Madison and Monroe counties, running from Alton and Godfrey in the north to Columbia and Waterloo in the south. It takes in river towns on the floodplain, older cities such as Belleville and Granite City, growing suburbs like Edwardsville and O’Fallon, and farm communities to the east. A good deal of the region’s specialty care sits across the river in Missouri, and a bridge crossing is a real obstacle for someone who is frail or in pain. Care arranged close to home matters here.

Care at home

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

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.

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.

Primary care and overall health

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 the Metro East →

Getting care arranged in the Metro East

Clinicians and facility staff referring a patient for diabetic foot ulcer care in the Metro East can call 314-325-0126 or fax 314-786-7966. Helpful to include: demographics and insurance, the working diagnosis, recent wound notes and measurements, current orders, the medication list and relevant test results. Please also tell us who should receive the treating clinician’s notes afterward. The online referral form takes contact details only, so clinical records should come by fax, not through the form. Gateway confirms that the referral arrived, checks availability for the patient’s address and lets your office know what has been scheduled.

Patients in the Metro East come home from many hospitals, including Memorial Hospital Belleville, Memorial Hospital Shiloh, HSHS St. Elizabeth’s Hospital in O’Fallon, Illinois, Anderson Hospital in Maryville, Alton Memorial Hospital, OSF Saint Anthony’s Health Center in Alton, Gateway Regional Medical Center in Granite City and Touchette Regional Hospital in Cahokia Heights. Gateway Wound Care is not affiliated with them. Whichever hospital it was, a family member or discharge planner can ask us to arrange follow-up. We obtain the discharge orders and set up a visit with a partner clinician at the home or facility.

• County: St. Clair, Madison and Monroe counties, Illinois
• Nearby hospitals: Memorial Hospital Belleville; Memorial Hospital Shiloh; HSHS St. Elizabeth's Hospital in O'Fallon, Illinois; Anderson Hospital in Maryville; Alton Memorial Hospital; OSF Saint Anthony's Health Center in Alton; Gateway Regional Medical Center in Granite City; Touchette Regional Hospital in Cahokia Heights (not affiliated with Gateway)
• Nearby communities: Belleville, Illinois, Edwardsville, O'Fallon, Illinois, Collinsville, Alton, Granite City
• 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 the Metro East page.

• Venous leg 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
• Diabetic foot ulcer care in Belleville
• Diabetic foot ulcer care in Edwardsville
• Diabetic foot ulcer care in O'Fallon
• Diabetic foot ulcer care in Collinsville

Common questions