About 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.

How the care plan is built

A first visit for a venous leg ulcer covers more than the wound. The treating clinician typically records:

  • Where the ulcer sits, and its length, width and depth
  • The appearance of the wound base and edges
  • How much drainage there is and what it looks like
  • The surrounding skin: staining, hardening, rash, or pale soggy areas
  • Swelling in both legs, often measured at the ankle and calf
  • Pain, and what makes it better or worse

Those findings become the baseline. The same points are checked again at later visits, so the care plan is adjusted on what the leg is doing, not on guesswork.

Local context: St. Peters

In St. Peters, a vein specialist or vascular lab can be a long drive away, and a car ride is hard on a venous ulcer. Sitting with the knees bent and feet on the floor for a long stretch each way lets fluid settle in the lower legs. When routine wrap changes and wound checks happen at home, those drives can be saved for appointments that truly need a specialist’s equipment. Gateway arranges home visits with a partner clinician, helps schedule any testing the clinician orders, and groups appointments where possible so one trip covers more than one need.

Most people in St. Peters live in single-family subdivisions, and many of those houses are split-level or two-story, with the bedrooms up a flight of stairs. There are also apartment complexes, condominiums, villas for older adults, assisted living, memory care and skilled nursing facilities. Gateway arranges visits with partner clinicians in any of these settings. For a home visit we confirm the address and who will be there. For a facility visit we work with the nursing staff on timing, records and orders so the visit fits the resident’s day.

Care at home

Family caregivers often carry part of the work for a venous leg ulcer at home. Depending on the orders, that might mean helping with a stocking or adjustable garment, changing an outer dressing, propping the legs at rest, or watching the toes and skin for changes. No one should have to guess. The treating clinician can show a caregiver which tasks are theirs and which to leave alone, and Gateway can request visit times when the caregiver is able to be there. If the caregiver works, travels or lives elsewhere, tell us, and with your permission we will keep them informed by phone.

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.

Signs to tell the clinician about

Venous leg ulcers can become infected, and infection in the skin of the leg can spread. Report these changes to the treating clinician promptly:

  • Redness, warmth or swelling that is spreading beyond the ulcer
  • Pain that is getting worse instead of better
  • Thick, cloudy or foul-smelling drainage
  • Fever, chills or feeling generally unwell
  • An ulcer that is suddenly larger or deeper

Call 911 for chest pain, shortness of breath, confusion or fainting, or bleeding from the leg that does not stop with firm, steady pressure.

Why primary care matters here

Venous disease is a long-term condition, and the ulcer is one episode in it. Once the skin closes, someone needs to keep watching the legs, renew orders for compression garments as they wear out, and decide whether a referral to a vein specialist makes sense. That ongoing role usually belongs to primary care. A primary care clinician also weighs how other treatments affect the leg, such as blood thinners after a clot or a change in blood pressure medicine. For patients without a regular clinician, or who can no longer get to an office, Gateway can arrange primary care visits alongside wound care so follow-up continues.

Primary care at home in St. Peters →

Getting care arranged in St. Peters

Before anything is scheduled, Gateway checks two things for every request for venous leg ulcer care in St. Peters: 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 St. Peters Hospital sits within the city, and many residents also receive care at SSM Health St. Joseph Hospital in St. Charles or Progress West Hospital in O’Fallon. Gateway is not affiliated with any of them. If you or a relative is coming home from one of these hospitals with a wound or a new care need, you can call us before or after discharge. Discharge planners and case managers can refer by phone or fax, and we coordinate records, the clinician’s orders and the first visit with a partner clinician.

  • County: St. Charles County, Missouri
  • ZIP codes: 63376
  • Nearby hospitals: Barnes-Jewish St. Peters Hospital; SSM Health St. Joseph Hospital in St. Charles; Progress West Hospital in O'Fallon (not affiliated with Gateway)
  • Nearby communities: St. Charles, O'Fallon, Missouri, Cottleville, Weldon Spring, St. Charles County
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

More wound care in St. Peters

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

Common questions

Who arranges long-term compression garments for patients in St. Peters 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.

Can I shower or bathe with a compression wrap on?

Most wraps need to stay dry, because a wet wrap can irritate skin and lose its hold. How you bathe depends on the type of compression ordered. Some garments come off for bathing, while layered wraps usually stay on until the next change. Ask the treating clinician what applies to you and which cover, if any, they suggest. Report a wrap that gets wet.

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.

Can Gateway arrange a visit at an assisted living community in St. Peters?

Yes. Assisted living, memory care and skilled nursing residents in St. Peters can receive visits where they live. A family member or a staff member can make the request. Gateway works with the staff on timing, shares the treating clinician’s orders with them and keeps the family informed, so everyone caring for the resident follows the same plan.

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.