What to know about arterial and mixed wounds

An arterial ulcer is an open sore that develops because the arteries feeding the leg or foot have narrowed and can no longer carry enough blood to keep skin alive and repair it. Clinicians also call these ischemic wounds. They show up most on the tips of the toes, between the toes, on the heel, over the ankle bone and along the shin, places far from the heart or pressed on by shoes. The sore is often small, deep and dry, with a clean border. A mixed wound, sometimes called a mixed arterial-venous ulcer, sits on a leg where the veins are also failing, so swelling and drainage appear alongside the signs of a poor arterial supply.

What an assessment covers

A care plan for an arterial wound usually runs on two tracks. One protects the wound: dressings matched to how dry or moist it is, padding and footwear that keep pressure and friction off the area, and a close watch for infection. The other addresses the blood supply, which may mean a referral to a vascular specialist to see whether a procedure could open or bypass the narrowed artery.

The treating clinician sets the order of these steps. Until circulation is understood, the plan tends to be cautious, with an emphasis on keeping stable tissue stable instead of pushing for fast changes at the wound.

Arterial and mixed wound care in Washington

Feet with poor circulation take more knocks in Washington than people expect: work boots, gravel drives, uneven ground and cold mornings outdoors. With fewer specialists close by, a small injury can go unexamined for a while. Care brought to the home shortens that gap. The treating clinician checks the wound and both feet at each visit, reviews footwear, and decides when a trip for circulation testing is warranted. Gateway arranges those visits, confirms availability for your location first, and coordinates supply orders early so a long gap between deliveries does not leave you short.

In Washington you will find older houses near the riverfront downtown, newer subdivisions on the edges of the city, apartments, and farmhouses and homes on acreage in the countryside beyond. Senior apartments, assisted living and skilled nursing facilities serve the city and the smaller towns around it. Gateway arranges visits with partner clinicians in these settings. Because Washington is farther out than most communities we coordinate, we confirm availability by address before anything is scheduled. Clear directions matter on rural routes, so we ask for them.

Care at home

Between visits, most of the daily work falls to you or a caregiver, guided by the clinician’s written instructions. That usually means looking at both feet every day, including between the toes and the backs of the heels, keeping the dressing as ordered, and wearing the footwear or heel protection the clinician recommended.

Gateway stays involved during these stretches. If something changes, a call to 314-325-0126 gets the message to the treating clinician’s team. If a vascular appointment is coming up, we confirm the date, the records and the ride so the trip is not wasted.

In a facility

Residents in memory care may not be able to say that a foot hurts or remember bumping a shin. With arterial disease, that makes staff observation the main early warning. Pain may show up as restlessness at night, guarding a foot, refusing shoes or pulling at a dressing.

The treating clinician takes these reports seriously and builds a plan the unit can carry out, with dressings that stay in place and footwear that protects without rubbing. Gateway coordinates visits around the resident’s routine, keeps the attending physician informed and gives the family one contact for updates.

Changes to report

Arterial wounds can change quietly, so small differences are worth a call. Contact the treating clinician’s team promptly if you notice:

  • Pain that is stronger, or that now wakes you at night
  • A toe or patch of skin turning dusky, purple or black
  • The wound getting wider or deeper
  • New drainage or odor, or a dry scab turning soft
  • Redness or warmth spreading out from the wound

Call 911 if a foot or leg suddenly turns cold, pale or blue, goes numb, or becomes severely painful or hard to move. A sudden loss of blood flow is an emergency.

Primary care and overall health

Healing draws on the whole body. High blood sugar damages small vessels and weakens the response to infection. Kidney disease, anemia and a poor appetite each limit what reaches the wound. A primary care clinician can check labs, review how well diabetes is controlled, and look at whether you are eating enough protein and calories to rebuild tissue.

When wound care and primary care are arranged together, a wound that stalls prompts a wider look at health and not only a change of dressing. Findings from either visit reach the other clinician through Gateway’s coordination.

Primary care at home in Washington →

How to get started in Washington

Setting up arterial and mixed wound care for someone in Washington usually goes in this order:

  1. You call 314-325-0126 or send the request care form, which asks only for a name and phone number.
  2. Gateway talks with you about the wound, the address and the insurance.
  3. We confirm availability for that location and gather records for the treating clinician.
  4. The clinician visits, assesses the wound and writes the orders.
  5. We follow up on supplies, the next visit and communication with your other clinicians.

You do not need a confirmed diagnosis to start.

Calling about someone in Washington? Have the full address ready, including a county road or highway number if the home is outside the city, plus landmarks that help a visitor find the driveway. We will also ask for a callback number, the doctor’s name and any recent hospital paperwork. Gateway coordinates care elsewhere in Franklin County and in Eureka and Wildwood to the east. Because of the distances involved, knowing the exact address early helps us confirm what can be arranged.

  • County: Franklin County, Missouri
  • ZIP codes: 63090
  • Nearby hospitals: Mercy Hospital Washington (not affiliated with Gateway)
  • Nearby communities: Franklin County, Eureka, Wildwood
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in Washington

Read the full guide to arterial and mixed wounds, or see everything Gateway arranges on the mobile wound care in Washington page.

Common questions

Can a wound care clinician come to a home in Washington to look at an arterial ulcer?

Gateway arranges home visits from partner clinicians for arterial and mixed wounds, and availability is confirmed by location and care setting. Call 314-325-0126 or send a callback request with your name and phone number. We will ask where in Washington the patient lives, what kind of home or facility it is, and whether any vascular records exist, then explain what happens next.

Can an arterial ulcer heal without a procedure to open the artery?

Some do and some do not. It depends mainly on how much blood is reaching the area, along with infection, diabetes control and overall health. The treating clinician and, when involved, a vascular specialist weigh whether local wound care is likely to be enough or whether improving blood flow should come first. Not everyone is a candidate for a procedure, and in that case the plan centers on protection and comfort.

Is walking good or bad when I have a foot wound from poor circulation?

Walking is commonly recommended for artery disease in general, but an open wound on the foot changes the picture. Pressure and rubbing can hold a wound back, and the right shoe or protective device matters. Ask the treating clinician how much to walk, what to wear on the foot and whether any part of it should be kept free of weight. The answer is individual.

My mother was sent from Washington to a St. Louis hospital. Can follow-up happen back home?

That is a common situation. When she is discharged back to Washington, you or the hospital’s case manager can contact Gateway. We request the records from the hospital, coordinate orders with the treating clinician and arrange follow-up at her home or facility, subject to availability for her address. Routine checks then may not require another long drive.

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.