Understanding venous leg ulcers
A venous leg ulcer is a break in the skin of the lower leg that stays open because the veins beneath it are not doing their job. Most appear between mid-calf and ankle, commonly on the inner side near the ankle bone. They are usually shallow, with an irregular outline and a moist red or yellowish base. Drainage can be heavy enough to soak through dressings and socks.
The skin nearby tells part of the story. It may look stained brown or purple, feel tight, hard or itchy, and swell more as the day goes on. Pain varies. Some people feel a dull ache that eases when the leg is raised, and others feel very little.
What an assessment covers
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.
Local context: South County
Many people with venous leg ulcers in South County have lived in the same house for decades, and some later move to a senior living community or skilled nursing facility a short drive away. The ulcer plan should move with them. Gateway keeps track of the measurements, compression orders and supply details, so when someone goes from home to a rehabilitation stay and back, the receiving nurses know what was on the leg and why. Because partner clinicians see patients in both homes and facilities, the plan can often continue without starting the assessment over.
Care settings in South County are varied. Affton and Lemay have small brick bungalows and older two-bedroom homes. Concord, Sappington and Mehlville are known for ranch houses. Oakville and Sunset Hills have newer and larger homes. Throughout the area there are condominiums, senior apartments, assisted living, memory care and many skilled nursing and rehabilitation centers. Gateway arranges partner clinician visits in all of them. We fit the request to the setting, whether that means a kitchen-table visit in Affton or a visit planned with the nursing staff at a facility.
When care happens at home
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.
Care in skilled nursing and assisted living
In a skilled nursing facility, venous leg ulcer care is shared work. The partner clinician sees the resident on site, assesses the ulcer and the circulation, and writes or recommends orders in line with the facility’s process. Nursing staff carry out dressing changes and compression between visits and document what they see. Gateway keeps the two connected by scheduling rounds with the facility, sending visit notes and following up on open questions. The attending physician stays informed and remains in charge of the resident’s overall medical care, including the heart, kidney and medication issues that affect leg swelling.
Signs to tell the clinician about
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.
Primary care and overall health
The calf muscle acts as a pump for the leg veins, and it only works when the ankle moves. Arthritis, nerve damage, an old injury, pain from the ulcer itself or fear of falling can shrink a person’s walking to a few steps a day. A primary care clinician can look at what is limiting movement, manage pain, review fall risk and order physical therapy or equipment when appropriate. Sleep is part of this too. People who sleep upright in a recliner because of breathing trouble or back pain keep their legs down all night, and the reason behind that habit needs a medical answer.
Getting care arranged in South County
To arrange venous leg ulcer care in South County, call Gateway at 314-325-0126. Patients, family members and caregivers can call directly, and a referral is not required. We will ask where the patient lives, what has been done for the wound so far and which clinicians are involved. Gateway then confirms whether a partner clinician is available for that address and care setting, requests the relevant records and schedules the visit. At that visit the treating clinician examines the wound and decides on the plan. Our job from then on is the coordination: orders, supplies, follow-up visits and keeping the care team informed.
Mercy Hospital South is the hospital most South County residents know best. SSM Health St. Clare Hospital in Fenton and St. Luke’s Des Peres Hospital are used by many people on the western and northwestern sides. None of them is affiliated with Gateway. For discharge planners, a referral by phone or fax with the summary, wound orders and a family contact is enough to start. For families, one call to 314-325-0126 before or after discharge works. We then look for a partner clinician for the patient’s home or facility and confirm what happens next.
- County: St. Louis County, Missouri
- ZIP codes: 63123, 63125, 63126, 63127, 63128, 63129
- Nearby hospitals: Mercy Hospital South; SSM Health St. Clare Hospital in Fenton; St. Luke's Des Peres Hospital (not affiliated with Gateway)
- Nearby communities: Affton, Mehlville, Oakville, Crestwood, Sunset Hills, Fenton
- Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation
Related care in South County
Read the full guide to venous leg ulcers, or see everything Gateway arranges on the mobile wound care in South 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 Affton
- Venous leg ulcer care in Mehlville
- Venous leg ulcer care in Oakville
Common questions
Who arranges long-term compression garments for patients in South County once an ulcer has closed?
The treating clinician or your primary care clinician decides whether you need ongoing compression and at what strength. Garments usually require measuring, and they wear out and need replacing. Gateway can coordinate the order, the fitting and reminders for replacement, and can arrange primary care follow-up if you do not have a regular clinician. Payment for garments depends on your plan.
What is the difference between a venous ulcer and an arterial ulcer?
Venous ulcers come from blood pooling in the leg. They tend to be shallow, wet and located near the ankle on a swollen leg. Arterial ulcers come from too little blood reaching the tissue and are often on the toes, foot or shin, with a dry base and pain that worsens when the leg is raised. Some people have both. Telling them apart takes a clinical exam and circulation testing.
Will Medicare or my insurance pay for compression supplies and visits?
You can ask us about Medicare, Medicare Advantage, Medicaid and commercial plans. What is paid for depends on the treating provider, your specific plan and the care that is needed, and rules for compression garments and dressings vary a good deal from plan to plan. Gateway helps confirm the details before care starts so you can decide with clear information.
My parents live in South County, one at home and one in a nursing facility. Can Gateway help with both?
Yes. Gateway arranges care in private homes and in skilled nursing, assisted living and memory care settings across South County, so both parents can be part of one conversation. Each parent may have a different treating clinician depending on location and needs. Tell us who the main family contact is, and with your parents’ permission we will keep that person informed about visits and orders for both.
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.