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

Clinicians grade diabetic foot ulcers by severity, and the grade shapes what follows. A shallow wound with good blood flow and no infection can often be managed with visits at home or in a facility. A wound with spreading infection, exposed bone or tendon, or poor circulation may need a hospital, a surgeon or a vascular specialist, and the treating clinician will tell you if that is the case. Between those two ends, the clinician weighs what can be done on site against what calls for imaging, lab work or a specialist’s opinion. Gateway’s part is to move the resulting orders and referrals along and to let you know who should be calling you.

Diabetic foot ulcer care in the City of St. Louis

In the City of St. Louis, a walk-up apartment or a house with the bedroom on the second floor turns offloading into a daily problem. Every trip up the stairs loads the front of the foot, and a removable boot is awkward on narrow treads. A treating clinician who visits at home can see the stairs firsthand and tailor instructions, for instance whether to limit trips or sleep downstairs for a while. Gateway asks about buzzer codes, elevators and parking before the visit, so the time goes to the foot and not to getting through the front door.

The City of St. Louis is its own jurisdiction, separate from St. Louis County, and stretches from the Mississippi riverfront west to Forest Park and the county line. Inside it are dozens of distinct neighborhoods, from Downtown and Soulard to the Central West End, The Hill and the north side. The city is dense, old and largely built of brick, and many households do not have a car. For someone managing a wound or several chronic conditions, getting to appointments by bus or by borrowed ride is a recurring struggle that care at home can ease.

When care happens at home

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.

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.

Signs to tell the clinician about

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

The blood that reaches the foot is what feeds a healing ulcer, and the health of the arteries is largely a primary care matter. Blood pressure, cholesterol, kidney function and tobacco use all affect the vessels in the legs. A primary care clinician tracks these, orders the lab work and can coordinate referrals to vascular or kidney specialists when the wound clinician raises a concern. Leg swelling from heart or kidney conditions matters as well, because a swollen foot fits poorly in an offloading device. When Gateway arranges both kinds of care, findings from one visit can inform the other instead of sitting in separate charts.

Primary care at home in the City of St. Louis →

Arranging diabetic foot ulcer care in the City of St. Louis

Before anything is scheduled, Gateway checks two things for every request for diabetic foot ulcer care in the City of St. Louis: whether a partner clinician serves that address and care setting, and what the patient’s plan requires from the treating provider. Neither is assumed. If both line up, we arrange the visit and gather records. If something stands in the way, we say so, and our guide to following up on a request explains what to ask next. Gateway coordinates the care and does not make clinical decisions. Those belong to the treating clinician who sees the wound. Start by calling 314-325-0126, or ask a family member to call for you.

Barnes-Jewish Hospital, beside Forest Park, and SSM Health Saint Louis University Hospital, on Grand Boulevard, are the two major hospitals in the City of St. Louis. Gateway is not affiliated with either. Both discharge patients to every part of the city, and some go home with wounds that need regular attention. Case managers and social workers can refer by phone at 314-325-0126 or by fax at 314-786-7966. Families can call directly. Once we have the discharge summary and orders, we look for a partner clinician for the patient’s neighborhood and report back.

  • County: City of St. Louis, Missouri (an independent city)
  • ZIP codes: 63101, 63103, 63104, 63106, 63108, 63109, 63110, 63111, 63112, 63113, 63115, 63116, 63118, 63139, 63147
  • Nearby hospitals: Barnes-Jewish Hospital; SSM Health Saint Louis University Hospital (not affiliated with Gateway)
  • Nearby communities: Downtown St. Louis, Central West End, North St. Louis, South St. Louis, Clayton and Central County
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

More wound care in the City of St. Louis

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

Common questions

Can a wound care clinician come to a home in the City of St. Louis for a diabetic foot ulcer?

In many cases, yes. Gateway arranges home visits with partner clinicians across the region, and we confirm availability for your address and care setting when you call. You do not need a referral to ask. If you have a podiatrist or primary care doctor, have the office name ready so we can request records before the first visit.

What should I have ready for the first visit?

Gather a current medication list, recent blood sugar readings if you keep them, and any hospital or clinic papers about the foot. Set out the shoes, inserts, boot or other devices you use, along with the dressing supplies you have on hand. Write down the names of your doctors and your questions. A chair with good light and a place to prop the foot make the exam easier.

How often will the clinician visit for a diabetic foot ulcer?

The treating clinician sets the schedule based on how severe the wound is, the dressing plan and who is helping between visits. The frequency often changes as the ulcer improves or if a problem appears. Gateway does not promise a specific timetable, and visit availability is confirmed by location and care setting. If something changes before the next visit, call us so the clinician can decide what to do.

My father in the City of St. Louis has both Medicare and Medicaid. Can we still ask about home visits?

Yes. You can ask about Medicare, Medicare Advantage, Medicaid and commercial plans, alone or in combination. Whether a visit is a covered benefit depends on the treating provider, the plan and the care your father needs, so Gateway cannot tell you ahead of time that something is a covered benefit. Have both cards with you when you call 314-325-0126, and we will explain what the treating practice needs to check.

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.