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.

How the care plan is built

The wound is only part of the exam. The treating clinician also checks the foot and leg for whatever caused the ulcer and could keep it open:

  • Sensation, often tested with a thin filament touched to several spots
  • Pulses at the ankle and the top of the foot, skin temperature and color
  • Foot shape, callus, nail problems and the skin between the toes
  • The other foot, which shares the same risks
  • Shoes, insoles and socks, including wear patterns inside the shoe

If pulses are weak, the clinician may order a circulation study or a vascular referral before deciding how to approach the wound itself.

Local context: St. Louis County

In St. Louis County, a person with a foot ulcer is often a long-time homeowner whose spouse or neighbor helps out, and whose podiatrist and primary care doctor are close by. That existing circle is an asset. Gateway sends updates to each office after wound visits, so the people who know the patient are not working from old information. Seniors who have moved to an independent or assisted living community nearby can be seen there too. In either setting, show the clinician the worn house shoes by the door, because comfortable old footwear is a frequent source of rubbing.

St. Louis County wraps around the City of St. Louis on three sides, reaching from the Missouri River in North County to the Meramec River in the south and west past Chesterfield toward Franklin County. It is made up of dozens of municipalities plus large unincorporated areas, linked by Interstates 270, 64, 44, 55, 70 and 170. Distances add up here. For someone with a wound, a walker or a wheelchair, a drive across the county to an appointment can take most of a day, which is why care at home or in a facility matters.

Care at home

A home visit for a diabetic foot ulcer shows the treating clinician things a clinic never does: the slippers by the bed, the step down into the garage, the route to the bathroom at night. During the visit the clinician examines the wound, provides the care that is needed and updates the orders. Gateway schedules the visit, confirms the address and how to get in, and sends records ahead so the clinician arrives informed. Afterward we follow up on whatever was ordered, such as a boot, dressing supplies or a test, so those items are not left waiting on a phone call.

In a facility

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

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

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. Louis County →

How to get started in St. Louis County

Before anything is scheduled, Gateway checks two things for every request for diabetic foot ulcer care in St. Louis County: 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.

Where someone is hospitalized in St. Louis County usually depends on where they live. West County families often use Mercy Hospital St. Louis in Creve Coeur, Missouri Baptist Medical Center in Town and Country or St. Luke’s Hospital in Chesterfield. South County has Mercy Hospital South and SSM Health St. Clare Hospital in Fenton. North County has Christian Hospital and SSM Health DePaul Hospital in Bridgeton, and Mid County has SSM Health St. Mary’s Hospital in Richmond Heights. Gateway is not affiliated with these hospitals. After discharge, families and discharge planners can contact us to arrange follow-up.

  • County: St. Louis County, Missouri
  • Nearby hospitals: Mercy Hospital St. Louis in Creve Coeur; Missouri Baptist Medical Center in Town and Country; St. Luke's Hospital in Chesterfield; Mercy Hospital South; Christian Hospital in North County; SSM Health DePaul Hospital in Bridgeton; SSM Health St. Mary's Hospital in Richmond Heights; SSM Health St. Clare Hospital in Fenton (not affiliated with Gateway)
  • Nearby communities: North County, South County, Chesterfield and West County, Clayton and Central County, Kirkwood, Florissant
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

More wound care in St. Louis County

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

Common questions

Does Medicare or Medicaid pay for diabetic foot ulcer care in St. Louis County?

We cannot say in advance. Coverage depends on the treating provider, your specific plan and the care that is ordered, and the rules for visits, dressings and offloading devices can differ. You can ask us about Medicare, Medicare Advantage, Medicaid and commercial plans. Gateway checks what it can with the provider and the plan before the first visit and tells you what we find.

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.

My parent lives in a nursing home in St. Louis 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.

Does Gateway arrange care in unincorporated St. Louis County?

Yes. Gateway coordinates care across St. Louis County, in incorporated cities and in unincorporated neighborhoods alike. What matters is the street address and the care setting, not which local government serves the block. When you call 314-325-0126, give the full address and ZIP code, and we will confirm whether a visit with a partner clinician can be arranged there.

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.