Diabetic foot ulcer care in South St. Louis.

About 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: South St. Louis

City living in South 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.

South St. Louis means the city neighborhoods generally along and south of Interstate 44: Tower Grove, Dutchtown, Carondelet, The Hill, Soulard, St. Louis Hills and many more, each with its own corner shops, churches and parks. Grand Boulevard, Gravois Avenue, Kingshighway and Hampton Avenue carry the traffic, and Tower Grove Park and Carondelet Park anchor the map. People here are loyal to their blocks. An older resident may have lived within a mile of the same parish all their life, and care at home lets that continue when getting out becomes difficult.

At home between visits

Most of the time a foot ulcer spends healing falls between visits, so the plan for those days matters. The treating clinician will spell out how often the dressing is changed, who changes it, how much walking is allowed and what goes on the foot indoors, including short trips to the bathroom at night. Keeping the offloading boot or shoe beside the bed makes those trips easier to do correctly. A simple daily routine helps: look at both feet, check whether drainage has soaked through the dressing, and write down anything new. If a question comes up, call Gateway and we will pass it to the treating 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

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.

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 South St. Louis →

How to get started in South St. Louis

Clinicians and facility staff referring a patient for diabetic foot ulcer care in South St. Louis 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.

South St. Louis patients are discharged from several hospitals, most often SSM Health Saint Louis University Hospital, Barnes-Jewish Hospital, SSM Health St. Mary’s Hospital in Richmond Heights and Mercy Hospital South. Gateway is an independent company and is not affiliated with any of them. Hospital social workers and case managers can refer a patient going home to the south side by phone or fax. Family members can call as well. We ask for the discharge summary and current wound orders, find out who helps the patient at home, and confirm a partner clinician’s availability for that neighborhood.

• County: City of St. Louis, Missouri (an independent city)
• ZIP codes: 63104, 63109, 63111, 63116, 63118, 63139
• Nearby hospitals: SSM Health Saint Louis University Hospital; Barnes-Jewish Hospital; SSM Health St. Mary's Hospital in Richmond Heights; Mercy Hospital South (not affiliated with Gateway)
• Nearby communities: St. Louis City, Downtown St. Louis, Affton, Shrewsbury, Maplewood, Central West End
• 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 South 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 Affton
• Diabetic foot ulcer care in the Central West End

Common questions