Diabetic foot ulcer care in Washington, Missouri.

Understanding diabetic foot ulcers

The most common mistake with a diabetic foot ulcer is judging it by pain. A numb foot can carry a deep wound that feels like nothing at all. A second mistake is assuming a small opening means a small problem, when the damage under a callus can be wider than the hole in the skin. People also tend to think that keeping the wound covered is the whole treatment, yet a good dressing does little if the foot still bears weight on that spot all day. And many people believe an ulcer leads straight to amputation. It does not have to. Early attention, pressure relief and steady follow-up are what clinicians rely on to protect the foot.

What the treating clinician looks at

At the first visit the treating clinician usually measures the length, width and depth of the ulcer and notes what the base looks like: pink or red tissue, yellow slough, dark dead tissue, or structures that should not be visible. The edges get attention too, because a thick rim of callus or skin that has been undermined changes the plan. The amount, color and odor of any drainage are recorded. The clinician may also check whether the wound reaches toward bone, since that raises the question of bone infection and may lead to imaging or lab work. These findings become the baseline that later visits are measured against.

Local context: Washington, Missouri

In Washington, the nearest wound specialist may be most of an hour away, and a foot ulcer that needs frequent checks turns that distance into a barrier. Care brought to the home removes much of it. Because a return trip is not quick, planning counts for more here. Gateway works with the treating clinician to keep enough dressings on hand to cover the gap between deliveries, and to have a backup plan if the offloading device breaks. We also confirm in advance which partner clinicians serve your address, since availability varies across the outer parts of the region.

Washington sits on the south bank of the Missouri River in Franklin County, well west of the St. Louis suburbs. It is the largest city in the county and the place surrounding farm communities come to for shopping, work and medical care. Highway 100 leads east toward St. Louis County and Highway 47 crosses the river to the north. Outside the city limits the roads turn rural fast. For a person with a wound who lives miles out, or who no longer drives, care arranged at home or in a local facility can replace a long round trip.

Care at home

Most of the time a foot ulcer spends healing falls between visits, so the plan for those days matters. The treating clinician will spell out how often the dressing is changed, who changes it, how much walking is allowed and what goes on the foot indoors, including short trips to the bathroom at night. Keeping the offloading boot or shoe beside the bed makes those trips easier to do correctly. A simple daily routine helps: look at both feet, check whether drainage has soaked through the dressing, and write down anything new. If a question comes up, call Gateway and we will pass it to the treating clinician.

In a facility

A resident with dementia may not remember having a foot wound, may pull off a dressing, or may refuse a boot that feels strange. Memory care teams know these patterns, and the treating clinician plans with them. That can mean choosing dressings that stay in place, timing care for a calmer part of the day, and asking staff which footwear the resident will keep on. Because the resident often cannot report pain or changes, staff observations carry extra weight. Gateway relays those observations to the clinician between visits and helps keep family members or legal decision-makers informed about the plan.

Signs to tell the clinician about

Infection is the change clinicians most want to hear about early, and in a numb foot it may not hurt. Contact the treating clinician promptly if you notice:

• Redness that is spreading, or a red streak moving up the foot or leg
• Skin around the ulcer that feels warmer than the other foot
• Thicker, cloudy or foul-smelling drainage
• New swelling of the foot or ankle
• Fever, chills or feeling generally unwell

Call 911 for confusion, a racing heart, trouble breathing or fainting. Gateway is not an emergency service.

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 Washington →

Getting care arranged in Washington

Setting up diabetic foot ulcer 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.

Mercy Hospital Washington is the hospital most local families know, and it is where many people in Washington are admitted or have surgery before coming home. Gateway is not affiliated with the hospital. When a discharge is planned, a relative or a discharge planner can call or fax us with the basics. We request the records, coordinate the treating clinician’s orders and arrange follow-up at the home or facility. Patients sent to a St. Louis hospital for specialty care and then returned to Washington can be referred the same way.

• 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

Other conditions and nearby communities

Read the full guide to diabetic foot ulcers, or see everything Gateway arranges on the mobile wound care in Washington 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 Franklin County
• Diabetic foot ulcer care in Wildwood

Common questions