What to know about venous leg ulcers

Leg veins have to push blood uphill. They rely on two helpers: one-way valves inside the vein, and the calf muscle, which squeezes the veins with every step. When valves wear out or are damaged by an old blood clot, blood slips backward and collects near the ankle. Pressure in those veins stays high whenever you sit or stand.

That pressure forces fluid and blood cells out into the tissue, which swells, stiffens and receives less oxygen and nourishment than healthy skin. Skin in that state is easy to injure and slow to mend. A scrape from a walker, an insect bite or scratching an itchy patch can be enough to start an ulcer.

How the care plan is built

Most care plans for a venous leg ulcer are built from the same parts, each set by the treating clinician for your leg:

  • Compression, if circulation allows it
  • A dressing schedule based on drainage
  • Cleansing and protection for the surrounding skin
  • Removal of unhealthy tissue when the clinician judges it necessary
  • Guidance on elevation, walking and ankle movement
  • A date to remeasure and review

The clinician writes the orders. Gateway then coordinates what the orders require: supplies, the visit schedule, and copies of the plan for home health, facility nursing or your primary care clinician. If the ulcer is not responding, the plan is reviewed and changed.

Venous leg ulcer care in South St. Louis

City housing shapes venous ulcer care in South St. Louis. A third-floor walk-up means the leg hangs down and works hard on every trip, and a bulky multi-layer wrap may not fit the shoes you trust on stairs. Tell us about steps, elevators, entry buzzers and where a visiting clinician can park, so the visit is not delayed at the door. Dressing and compression supplies sent to an apartment building can sit in a lobby or mailroom, so we ask who can receive packages. The clinician can also suggest where in a small apartment you can raise your legs comfortably.

Brick defines the south side. There are bungalows and gingerbread-style houses in St. Louis Hills, narrow shotgun homes on The Hill, row houses in Soulard, and two-family and four-family flats nearly everywhere. Front steps are steep, gangways are narrow and parking is on the street. Senior apartment buildings, assisted living and skilled nursing facilities are spread through the neighborhoods as well. Gateway arranges partner clinician visits in each setting. Tell us if the patient lives in an upstairs flat or needs help getting to the door, so the visit is planned with that in mind.

When care happens at home

When a home health agency is already visiting, its nurses commonly change dressings and reapply compression between the treating clinician’s visits. Gateway shares current orders with the agency so both work from the same plan, and we pass the nurses’ observations back. Supplies need the same attention. A draining venous ulcer can go through a large amount of absorbent dressings, padding and wrap layers in a week. We coordinate orders for the supplies the clinician specifies and check in before they run low. What a health plan pays for depends on the plan, the treating provider and the care needed.

For residents of nursing and senior living communities

Residents in memory care may not understand why a leg is wrapped. They may pull at the bandage, scratch the skin beneath it or be unable to say that it feels too tight. The treating clinician takes that into account when choosing dressings and compression, and may adjust the plan when a resident does not tolerate a wrap. Staff observations carry extra weight here. Restlessness, guarding the leg, a change in walking or a new refusal to wear shoes can all signal discomfort. Gateway shares the clinician’s instructions with the care team and keeps the family or legal representative updated on visits and changes.

What to report and when to call 911

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

A draining venous ulcer asks a lot of the body. Protein is lost in wound fluid, and healing skin needs steady calories, protein and fluids to rebuild. Older adults with a poor appetite, dental problems or a tight food budget can fall behind without anyone noticing. A primary care clinician can check weight trends and lab work, look for anemia, and review diabetes control, since high blood sugar slows repair and raises infection risk. Body weight matters as well, because extra weight adds pressure to leg veins. None of this replaces wound care. It supports it, which is why Gateway can arrange both.

Primary care at home in South St. Louis →

How to get started in South St. Louis

Setting up venous leg ulcer care for someone in South St. Louis usually goes in this order:

  1. You call 314-325-0126 or send the request care form, which asks only for a name and phone number.
  2. Gateway talks with you about the wound, the address and the insurance.
  3. We confirm availability for that location and gather records for the treating clinician.
  4. The clinician visits, assesses the wound and writes the orders.
  5. We follow up on supplies, the next visit and communication with your other clinicians.

You do not need a confirmed diagnosis to start.

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

Related care in South St. Louis

Read the full guide to venous leg ulcers, or see everything Gateway arranges on the mobile wound care in South St. Louis page.

Common questions

My mother lives in a nursing home in South St. Louis. Can Gateway arrange venous ulcer care there?

Often, yes. Partner clinicians see residents in skilled nursing, assisted living, memory care and rehabilitation settings, working alongside the facility’s nurses and the attending physician. Start by telling us the facility’s name, or ask its nursing staff to contact Gateway. We confirm whether visits are available at that location and what the facility needs in order to begin.

Should I walk or rest with a venous leg ulcer?

Usually some of each, as directed by your clinician. Walking and ankle movement work the calf muscle that pushes blood up the leg, while resting with the legs raised lets swelling drain. Long periods of standing still or sitting with the feet down tend to help least. Ask the treating clinician what balance is right for you, especially if you have heart, artery or balance problems.

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.

My aunt lives in an upstairs flat in South St. Louis and rarely goes out. Can she be seen at home?

Yes. Upstairs flats are common in South St. Louis, and visits can be arranged there. Tell us which door and stairway lead to her unit and whether she can let someone in. If she is hard of hearing or does not answer unfamiliar callers, give us a relative’s number too. The treating clinician decides what care she needs after seeing her.

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.