Diabetic foot ulcer care in University City.

Understanding 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 the treating clinician looks at

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.

Local context: University City

In University City, 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.

University City begins where the Delmar Loop meets the St. Louis city line and runs west toward Interstate 170. Delmar Boulevard and Olive Boulevard carry traffic through it, and Clayton, Olivette and Overland are next door. This inner-ring suburb is dense by St. Louis County standards, with houses set close together and some residents who do not drive. For an older adult in an upstairs flat, or a person recovering from surgery, the hard part of an appointment is often the stairs and the ride, not the visit itself. Care at home removes both.

At home between visits

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

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.

How primary care fits in

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 University City →

Arranging diabetic foot ulcer care in University City

If you have been managing a wound mostly on your own and are looking for diabetic foot ulcer care in University City, you can call Gateway yourself at 314-325-0126. Tell us what the wound looks like now, what the last clinician said about it and what is getting harder to manage. It helps to know the patient’s insurance and the names of the doctors involved, but do not wait until you have everything. We check whether a partner clinician can see the patient at home or in their facility, and we tell you what we find. The treating clinician takes it from there, and you stay part of the conversation.

Barnes-Jewish Hospital, a few miles east in the City of St. Louis, is where many University City residents have surgery or are admitted. Others use SSM Health St. Mary’s Hospital in Richmond Heights or Mercy Hospital St. Louis in Creve Coeur. Gateway has no affiliation with these hospitals. Our part comes after the discharge: a family member or a hospital case manager contacts us, we gather the records and the discharge orders, and we arrange follow-up with a partner clinician at the patient’s home or facility.

• County: St. Louis County, Missouri
• ZIP codes: 63130
• Nearby hospitals: Barnes-Jewish Hospital; SSM Health St. Mary's Hospital in Richmond Heights; Mercy Hospital St. Louis in Creve Coeur (not affiliated with Gateway)
• Nearby communities: Clayton and Central County, Overland, Central West End, Ladue, Creve Coeur
• Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

More wound care in University City

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

• Venous leg 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
• Diabetic foot ulcer care in Clayton and Central County
• Diabetic foot ulcer care in the Central West End
• Diabetic foot ulcer care in Ladue
• Diabetic foot ulcer care in Creve Coeur

Common questions