Understanding venous leg ulcers
Healing rarely moves in a straight line with a venous leg ulcer. Early in care, drainage often changes before size does, and a leg that is less swollen is usually an encouraging sign. The wound may even look larger for a time as unhealthy tissue clears from its edges.
Progress can stall when swelling returns, when compression is off for long stretches, or when an infection or skin reaction sets in. Clinicians compare measurements from visit to visit and rethink the plan if the ulcer stops changing. After the skin closes, the vein problem is still there, so these ulcers are known for returning unless swelling stays controlled over the long term.
What an assessment covers
The history shapes a venous ulcer plan as much as the exam does. The treating clinician asks how long the ulcer has been open, whether this leg has ulcerated before, and whether you have had a blood clot, a vein procedure, leg surgery or an injury. Allergies are reviewed, along with any skin reaction to past dressings, tapes or wraps, so the same products are not ordered again.
The clinician also asks what you have already tried and what happened. An ulcer that does not look or behave like a typical venous wound, or one that fails to respond, may lead to more tests or a referral to a vascular or skin specialist.
Local context: St. Louis County
Homes in St. Louis County are often older houses with upstairs bedrooms, basement laundry and a bathtub you have to step over. Each matters with a wrapped leg. Climbing in and out of a tub while keeping compression dry is a fall risk, and stairs may be the reason someone starts sleeping in a recliner with the legs down. During a home visit, the treating clinician can see all of this and suggest practical changes, and Gateway can coordinate ordered equipment such as a shower chair or a leg-elevating cushion. For long-time residents who want to stay put, those details matter.
Housing in St. Louis County changes by area. The inner suburbs and Mid County have older brick homes, two-story houses and apartment buildings. North County and South County have many one-story ranch homes on quiet streets. West County has newer subdivisions, condominiums and villas. Every part of the county also has skilled nursing facilities, assisted living, memory care and rehabilitation centers. Gateway arranges visits from partner clinicians in each of these settings and handles the scheduling, records, orders and supplies around the visit, whether the address is a house, an apartment or a facility room.
At home between visits
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
A short rehabilitation stay after surgery or a hospital admission can be a turning point for a venous leg ulcer. Legs often swell more after days in bed and long hours in a wheelchair with the feet down. Therapy sessions, on the other hand, rebuild the walking and ankle movement that help veins work. Partner clinicians see patients on site and coordinate with nursing and therapy on details such as wrap changes around therapy times and footwear that fits over compression. Before discharge, Gateway helps line up continued visits and supplies at home so the plan does not lapse during the move.
Changes to report
Some changes point beyond the ulcer to the rest of the body. Tell the treating clinician promptly about:
- New swelling, pain or tenderness in one calf or thigh
- Swelling that rises quickly in both legs
- Rapid weight gain over a few days
- Needing more pillows to breathe comfortably at night
- A fall or a new injury to the leg
Call 911 right away for sudden shortness of breath, chest pain, coughing up blood, or a racing heartbeat with lightheadedness. These can be signs of a blood clot in the lungs or a heart problem, and they should not wait for a scheduled visit.
Primary care and overall health
The calf muscle acts as a pump for the leg veins, and it only works when the ankle moves. Arthritis, nerve damage, an old injury, pain from the ulcer itself or fear of falling can shrink a person’s walking to a few steps a day. A primary care clinician can look at what is limiting movement, manage pain, review fall risk and order physical therapy or equipment when appropriate. Sleep is part of this too. People who sleep upright in a recliner because of breathing trouble or back pain keep their legs down all night, and the reason behind that habit needs a medical answer.
Getting care arranged in St. Louis County
Before anything is scheduled, Gateway checks two things for every request for venous leg 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
Other conditions and nearby communities
Read the full guide to venous leg ulcers, or see everything Gateway arranges on the mobile wound care in St. Louis County page.
- Diabetic foot 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
- Venous leg ulcer care in North County
- Venous leg ulcer care in South County
- Venous leg ulcer care in Chesterfield and West County
- Venous leg ulcer care in Clayton and Central County
Common questions
Who arranges long-term compression garments for patients in St. Louis County once an ulcer has closed?
The treating clinician or your primary care clinician decides whether you need ongoing compression and at what strength. Garments usually require measuring, and they wear out and need replacing. Gateway can coordinate the order, the fitting and reminders for replacement, and can arrange primary care follow-up if you do not have a regular clinician. Payment for garments depends on your plan.
How often will someone visit for a venous ulcer?
The treating clinician sets the schedule based on the leg. Heavy drainage or newly started compression often calls for more frequent changes, and visits may spread out as swelling and drainage settle. Home health nurses or facility staff sometimes handle changes in between. Gateway cannot promise a specific frequency or timing, since availability is confirmed by location and care setting.
Will Medicare or my insurance pay for compression supplies and visits?
You can ask us about Medicare, Medicare Advantage, Medicaid and commercial plans. What is paid for depends on the treating provider, your specific plan and the care that is needed, and rules for compression garments and dressings vary a good deal from plan to plan. Gateway helps confirm the details before care starts so you can decide with clear information.
My mail says St. Louis. Does it matter whether I live in the city or in St. Louis County?
Not for requesting care. Many St. Louis County homes have a St. Louis mailing address, and Gateway coordinates care in both the county and the City of St. Louis. Give us the street address and ZIP code and we will sort out the location. Visit availability is confirmed for that specific address and the care setting.
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.