Understanding diabetic foot ulcers

A diabetic foot ulcer is an open wound on the foot of a person with diabetes, deep enough that the full thickness of the skin is gone. Common places are the ball of the foot, the tips and tops of the toes, the heel and the outer edge of the foot. It can look like a shallow crater ringed with thick callus, or like a small hole that runs deeper than its opening suggests. Clinicians describe an ulcer by its location, size and depth, the tissue in its base, and whether infection or poor blood flow is present. Those descriptions guide what gets ordered, and they give everyone involved a shared way to tell whether the wound is improving.

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.

Arranging this care in St. Charles County

From St. Charles County, a wound center, a vascular lab or a podiatry office can be a long drive each way, and that drive usually depends on a family member taking time off work. Home visits for a diabetic foot ulcer cut down on those trips. When the adult child who helps with dressings commutes, the treating clinician can set a schedule around it, such as evening changes, or order home health nursing for the daytime. Gateway sends visit updates to the family contact you choose, so a caregiver at work can stay informed without being in the room.

St. Charles County lies between the Missouri River on the south and east and the Mississippi River on the north, a broad stretch of suburbs, small towns and farmland. Interstate 70 and Interstate 64 run through it, linking St. Charles, St. Peters, O’Fallon, Lake St. Louis and Wentzville, with Cottleville, Dardenne Prairie and Weldon Spring in between. The county has grown quickly, and it now has both young subdivisions and many retirees. Distances are long here. A patient in Wentzville and a specialist in St. Louis County can be a long highway drive apart, which makes care at home valuable.

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.

In a facility

Assisted living poses a particular challenge for diabetic foot ulcers. Residents are fairly independent, staff may not be permitted to change wound dressings, and a person can walk on a sore foot for days before anyone sees it. When Gateway arranges visits in an assisted living community, we ask who handles dressings between visits: facility staff, a home health nurse or family. The treating clinician shapes the plan around that answer. We also let the community’s nurse or wellness director know what to watch for, such as drainage on socks or a resident who has stopped wearing the prescribed shoe.

What to report and when to call 911

A foot ulcer can affect the whole body, and sometimes the first warning shows up away from the wound. Tell the treating clinician about:

  • Blood sugar readings that run higher than usual for no obvious reason
  • Nausea, poor appetite or unusual tiredness
  • New pain in a foot that normally feels very little
  • A sore, crack or callus appearing on the other foot
  • A fall, or an offloading device that is damaged or no longer fits

Call 911 for severe shortness of breath, chest pain, new confusion or a person who cannot be woken.

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.

Primary care at home in St. Charles County →

Getting care arranged in St. Charles County

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 St. Charles County. 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.

Four hospitals serve most of the county: SSM Health St. Joseph Hospital in St. Charles, SSM Health St. Joseph Hospital in Lake Saint Louis, Barnes-Jewish St. Peters Hospital and Progress West Hospital in O’Fallon. Gateway is not affiliated with any of them. Their discharge planners can refer patients returning to any St. Charles County address by phone or fax, and families can call on their own. Sending the discharge summary and wound orders at the start allows the treating clinician to review them before a first visit, wherever in the county the patient lives.

  • County: St. Charles County, Missouri
  • ZIP codes: 63301, 63303, 63304, 63376, 63366, 63368, 63385, 63367
  • Nearby hospitals: SSM Health St. Joseph Hospital in St. Charles; SSM Health St. Joseph Hospital in Lake Saint Louis; Barnes-Jewish St. Peters Hospital; Progress West Hospital in O'Fallon (not affiliated with Gateway)
  • Nearby communities: St. Charles, St. Peters, O'Fallon, Missouri, Wentzville, Lake St. Louis, Cottleville
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in St. Charles County

Read the full guide to diabetic foot ulcers, or see everything Gateway arranges on the mobile wound care in St. Charles County page.

Common questions

My parent lives in a nursing home in St. Charles County. Can Gateway arrange foot ulcer visits there?

You can ask, and we will confirm availability for that building. Partner clinicians see residents in skilled nursing, assisted living, memory care and rehabilitation settings. A facility has its own attending physician and nursing staff, so we coordinate with them before scheduling. Call us, or ask the director of nursing to send a referral. Updates go to family when the resident or legal representative agrees.

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.

Will the clinician remove tissue from the wound during a visit?

Possibly. Removing callus and dead tissue, called debridement, is a common part of diabetic foot ulcer care, because unhealthy tissue hides the true size of the wound and can hold bacteria. Whether it is done, by what method and how often is up to the treating clinician, who considers blood flow first. Ask what to expect afterward, since a freshly cleaned wound can look larger.

Which towns in St. Charles County does Gateway arrange care in?

Gateway arranges wound care and primary care in St. Charles, St. Peters, O’Fallon, Wentzville, Lake St. Louis, Cottleville, Dardenne Prairie and Weldon Spring, along with unincorporated parts of St. Charles County. For addresses in smaller or more rural communities, call 314-325-0126 and we will check. Availability always depends on the location and the care setting, and it is confirmed before a visit is scheduled.

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.