Diabetic foot ulcer care in Webster Groves.

Understanding diabetic foot ulcers

Change in a diabetic foot ulcer comes slowly, which is why the wound is measured at regular visits. In the early weeks of care, clinicians look for the wound to become smaller and shallower and for healthy red tissue to fill in the base. A wound that stays the same size visit after visit is a signal to look for a cause instead of simply waiting longer. Setbacks are common. A few days in the wrong shoes, or a stretch without the protective device, can undo progress. Once the skin closes, the area stays weaker than the skin around it, and ulcers often return at or near the same spot. The months after closure call for protective footwear and continued foot checks.

What the treating clinician looks at

The wound is only part of the exam. The treating clinician also checks the foot and leg for whatever caused the ulcer and could keep it open:

• Sensation, often tested with a thin filament touched to several spots
• Pulses at the ankle and the top of the foot, skin temperature and color
• Foot shape, callus, nail problems and the skin between the toes
• The other foot, which shares the same risks
• Shoes, insoles and socks, including wear patterns inside the shoe

If pulses are weak, the clinician may order a circulation study or a vascular referral before deciding how to approach the wound itself.

Local context: Webster Groves

In Webster Groves, 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.

Tall trees, deep front porches and houses that have stood for a century give Webster Groves its look. The city lies along Interstate 44 in St. Louis County, with Lockwood Avenue running through its center and Kirkwood, Shrewsbury and Crestwood nearby. Many residents have been here for decades and have no plans to leave. Those same older homes can be hard on someone with a leg wound or a recent surgery, since many have steps at every door. Arranging care at home, or in a nearby facility, spares the patient that climb.

Care at home

When dressings need changing more often than visits occur, the treating clinician may order home health nursing, and Gateway helps set that up with an agency that serves your area. The agency nurse follows the wound orders and reports changes back. Supplies are the other piece. Dressings, wraps and offloading devices are ordered by the clinician, and we track each order so the right sizes arrive before the current stock runs out. Store supplies together in one clean, dry place, and tell us early if a box is running low or if the boot or shoe no longer fits well.

In a facility

In a skilled nursing facility, a diabetic foot ulcer is managed by several people at once. A partner clinician visits on site to assess the wound and write or recommend orders, the facility nurses carry out dressing changes and daily skin checks, and the attending physician oversees the resident’s overall care. Gateway keeps those lines connected. We schedule rounds with the facility, send visit notes for the chart and confirm that new orders were received and signed as the building requires. Offloading orders, such as heel protection in bed or a boot for transfers, go to the nursing and therapy staff who apply them every shift.

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.

Primary care and overall health

Blood sugar and wound healing are closely tied. When glucose runs high over time, the cells that fight infection and rebuild tissue work less well, and an infected wound can in turn push readings higher. Wound visits do not manage diabetes medications. That belongs to the primary care clinician or endocrinologist, who may review recent readings, lab results and the current regimen while the ulcer is being cared for. Gateway helps the two sides share information, so the clinician managing diabetes knows there is an open wound and the wound clinician knows how glucose has been running.

Primary care at home in Webster Groves →

How to get started in Webster Groves

Setting up diabetic foot ulcer care for someone in Webster Groves 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.

After a hospital stay, Webster Groves residents often come home from SSM Health St. Mary’s Hospital in Richmond Heights, St. Luke’s Des Peres Hospital or Mercy Hospital South. None of these hospitals is affiliated with Gateway. If the discharge plan includes wound care, or the patient needs primary care follow-up and cannot easily get out, the family or the hospital’s discharge planner can contact us. We collect the discharge summary and orders, coordinate with a partner clinician and arrange follow-up visits where the patient is recovering.

• County: St. Louis County, Missouri
• ZIP codes: 63119
• Nearby hospitals: SSM Health St. Mary's Hospital in Richmond Heights; St. Luke's Des Peres Hospital; Mercy Hospital South (not affiliated with Gateway)
• Nearby communities: Kirkwood, Shrewsbury, Maplewood, Brentwood, Crestwood, Affton
• Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

More wound care in Webster Groves

Read the full guide to diabetic foot ulcers, or see everything Gateway arranges on the mobile wound care in Webster Groves 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 Kirkwood
• Diabetic foot ulcer care in Affton

Common questions