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
A care plan for a diabetic foot ulcer usually rests on a few parts that the treating clinician fits to the person. Pressure relief comes first, whether through a removable boot, a cast, a special shoe or limits on standing. Next is preparing the wound bed, which may mean removing callus and dead tissue during visits. A dressing is chosen to match the amount of drainage, and it may change as the wound does. Infection, if present, is addressed with the testing and treatment the clinician orders. Finally, the plan names who changes the dressings, how often visits happen, and what finding at follow-up would prompt a different approach.
Diabetic foot ulcer care in North St. Louis
City living in North St. Louis often means walking: to the bus stop, the corner store, the laundry room down the hall. Those steps add up on a foot that is supposed to be resting. A partner clinician visiting at home can talk through which trips matter and whether grocery or pharmacy delivery could replace the others. Large medical centers with podiatry and vascular specialists are usually a short ride away, and Gateway helps arrange transportation when the clinician orders testing there. Supply deliveries are planned around building access, since a box of dressings left in an open lobby can go missing.
North St. Louis is the common name for the city neighborhoods north of Delmar Boulevard, running up through The Ville, Fairground, Penrose, Walnut Park and Baden to the city limits. Natural Bridge Avenue, North Grand Boulevard, Kingshighway and Interstate 70 are the main routes. These are old neighborhoods with deep family roots, and many elders have lived on the same block most of their lives. The large hospitals are in the central corridor or out in the county, so a wound check or a doctor’s visit often means crossing town. Care at home shortens that distance.
When care happens at home
When dressings need changing more often than visits occur, the treating clinician may order home health nursing, and Gateway helps set that up with an agency that serves your area. The agency nurse follows the wound orders and reports changes back. Supplies are the other piece. Dressings, wraps and offloading devices are ordered by the clinician, and we track each order so the right sizes arrive before the current stock runs out. Store supplies together in one clean, dry place, and tell us early if a box is running low or if the boot or shoe no longer fits well.
Care in skilled nursing and assisted living
Rehabilitation stays add a tension to foot ulcer care: therapy wants the person up and walking, and the wound needs pressure kept off it. The treating clinician and the therapy team work out how to do both, for example by setting weight-bearing limits, naming the device to be worn during sessions and deciding how transfers are done. Gateway shares the wound orders with therapy and nursing so the instructions match. Before discharge we help arrange what comes next, including wound visits at home, the supplies that leave with the resident and a clear handoff to whoever will change dressings after the move.
Changes to report
Whoever changes the dressing is well placed to spot trouble. Let the treating clinician know if you see any of the following:
- Drainage soaking through sooner than it used to
- The wound measuring larger, or new openings nearby
- Skin around the wound turning white, soggy or raw
- A new blister or rubbed area where the boot, cast or shoe touches
- Fresh blood on a dressing that used to come off clean
Bleeding that will not stop with firm pressure, sudden weakness, slurred speech or difficulty breathing are reasons to call 911, not to wait for a call back.
Why primary care matters here
Healing an ulcer takes protein, calories and fluids, and that can pull against an eating plan built around blood sugar or kidney disease. Sorting out what to eat while a wound is open is a question for the primary care clinician or a dietitian. Medications deserve the same review. Some can affect swelling, blood sugar or healing, and only the prescribing clinician should adjust them. Arranging wound care and primary care together means these questions are asked by someone with the full medication list and recent lab results in hand, not saved for an appointment that is months away.
Getting care arranged in North St. Louis
You may already have a surgeon, a wound clinic or a home health nurse and still want help with diabetic foot ulcer care closer to home in North St. Louis. That is a fine reason to call 314-325-0126. Tell us who is treating the wound now and what is not working, whether that is the travel, the gaps between appointments or unclear instructions. Gateway does not replace your current clinicians. We can arrange for a partner clinician to see the wound where you live and, with your permission, share notes with the offices already involved so the plans agree.
For hospital care, people in North St. Louis commonly go to Barnes-Jewish Hospital, SSM Health Saint Louis University Hospital or Christian Hospital in North County. Gateway has no affiliation with any of them. A patient may be sent home with dressing instructions and a follow-up appointment that is hard to get to. Families can call us to ask whether wound care or primary care visits can be arranged at home. Discharge planners and social workers can refer by phone or fax, and should include the discharge summary, the orders and a working phone number for the patient or a relative.
- County: City of St. Louis, Missouri (an independent city)
- ZIP codes: 63106, 63107, 63113, 63115, 63120, 63147
- Nearby hospitals: Barnes-Jewish Hospital; SSM Health Saint Louis University Hospital; Christian Hospital in North County (not affiliated with Gateway)
- Nearby communities: St. Louis City, Downtown St. Louis, Central West End, Ferguson, North County
- Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation
Related care in North St. Louis
Read the full guide to diabetic foot ulcers, or see everything Gateway arranges on the mobile wound care in North St. Louis 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 the City of St. Louis
- Diabetic foot ulcer care in Downtown St. Louis
- Diabetic foot ulcer care in the Central West End
- Diabetic foot ulcer care in Ferguson
Common questions
Does Medicare or Medicaid pay for diabetic foot ulcer care in North St. Louis?
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.
What shoes should I wear once the ulcer has closed?
Footwear after closure is a medical decision more than a shopping one. Many people are measured for shoes and inserts made for diabetic feet, usually through a podiatrist or a footwear specialist on a clinician’s order. Going back to the shoes worn before the ulcer is a common reason wounds return. Ask the treating clinician when and how to move out of the offloading device.
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.
Do I need a doctor’s referral to ask for wound care in North St. Louis?
No. Patients, relatives and caregivers in North St. Louis can call Gateway directly at 314-325-0126 without a referral. Doctors, hospitals and facilities can also refer. If records or orders are needed, we request them with permission. The treating clinician decides what care is appropriate after assessing the patient. Whether a health plan requires a referral or authorization depends on the plan, and you can ask about that 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.