About 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.

How the care plan is built

Part of building a plan is finding out what a person can realistically do. Expect the treating clinician to ask questions such as:

  • How far do you walk in a day, and on what surfaces?
  • Can you see and reach the bottoms of your feet?
  • Who is available to help with dressings?
  • Have you had an ulcer, foot surgery or an amputation before?
  • What has already been tried on this wound?

The answers shape the choice of offloading device and the dressing schedule. A plan that fits daily life is one a person can keep following, and reassessment at each visit shows whether it is working.

Arranging this care in Wildwood

From Wildwood, a wound center, a vascular lab or a podiatry office can be a long drive each way, and that drive usually depends on a family member taking time off work. Home visits for a diabetic foot ulcer cut down on those trips. When the adult child who helps with dressings commutes, the treating clinician can set a schedule around it, such as evening changes, or order home health nursing for the daytime. Gateway sends visit updates to the family contact you choose, so a caregiver at work can stay informed without being in the room.

Wildwood covers a wide stretch of wooded hills at the far western edge of St. Louis County, where subdivisions give way to horse properties, creek valleys and parkland such as Babler State Park and Rockwoods Reservation. Highway 100 and Highway 109 are the main roads, and much of the rest is winding two-lane. The nearest hospitals and most clinics are a drive east. That distance is easy to accept until someone in the household has a wound that needs regular checks. Care arranged at home turns a long outing into a knock at the door.

At home between visits

A home visit for a diabetic foot ulcer shows the treating clinician things a clinic never does: the slippers by the bed, the step down into the garage, the route to the bathroom at night. During the visit the clinician examines the wound, provides the care that is needed and updates the orders. Gateway schedules the visit, confirms the address and how to get in, and sends records ahead so the clinician arrives informed. Afterward we follow up on whatever was ordered, such as a boot, dressing supplies or a test, so those items are not left waiting on a phone call.

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.

What to report and when to call 911

Whoever changes the dressing is well placed to spot trouble. Let the treating clinician know if you see any of the following:

  • Drainage soaking through sooner than it used to
  • The wound measuring larger, or new openings nearby
  • Skin around the wound turning white, soggy or raw
  • A new blister or rubbed area where the boot, cast or shoe touches
  • Fresh blood on a dressing that used to come off clean

Bleeding that will not stop with firm pressure, sudden weakness, slurred speech or difficulty breathing are reasons to call 911, not to wait for a call back.

How primary care fits in

Being told to keep weight off a foot changes daily life. A boot or cast can alter balance, raise the chance of a fall and make it harder to reach appointments, the pharmacy or the kitchen. Primary care looks at that wider picture: fall risk, vision, mood, sleep, vaccinations, and whether a walker, wheelchair or shower chair would help. For people who are homebound or have lost touch with a regular doctor, Gateway can arrange primary care visits alongside wound visits. With one coordinating point for both, it is less likely that the foot gets attention while the rest of a person’s health goes unwatched.

Primary care at home in Wildwood →

Getting care arranged in Wildwood

Before anything is scheduled, Gateway checks two things for every request for diabetic foot ulcer care in Wildwood: 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.

St. Luke’s Hospital in Chesterfield and Mercy Hospital St. Louis in Creve Coeur are hospitals Wildwood residents commonly use, and both are a meaningful drive from the western parts of the city. Gateway is not affiliated with either hospital. Returning for wound checks after a discharge can be tiring for the patient and the driver. Families can call us once a discharge date is known, and hospital discharge planners can refer directly. We gather records and orders and arrange follow-up with a partner clinician at home or in a facility.

  • County: St. Louis County, Missouri
  • ZIP codes: 63005, 63011, 63021, 63038, 63040
  • Nearby hospitals: St. Luke's Hospital in Chesterfield; Mercy Hospital St. Louis in Creve Coeur (not affiliated with Gateway)
  • Nearby communities: Chesterfield, Chesterfield and West County, Ballwin, Ellisville, Eureka, Franklin County
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

More wound care in Wildwood

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

Common questions

Can a wound care clinician come to a home in Wildwood for a diabetic foot ulcer?

In many cases, yes. Gateway arranges home visits with partner clinicians across the region, and we confirm availability for your address and care setting when you call. You do not need a referral to ask. If you have a podiatrist or primary care doctor, have the office name ready so we can request records before the first visit.

Can I shower or get my foot wet while I have an ulcer?

Ask the treating clinician, because the answer depends on the dressing and the offloading device. Some dressings must stay dry, and some casts cannot get wet at all. Soaking the feet is generally discouraged for people with diabetes, since it softens the skin and numb feet cannot judge water temperature. The clinician can suggest a safe way to bathe, such as a cover or a shower chair.

What should I have ready for the first visit?

Gather a current medication list, recent blood sugar readings if you keep them, and any hospital or clinic papers about the foot. Set out the shoes, inserts, boot or other devices you use, along with the dressing supplies you have on hand. Write down the names of your doctors and your questions. A chair with good light and a place to prop the foot make the exam easier.

Our Wildwood home is at the end of a long private drive. Does that affect a visit?

It should not prevent one, but tell us about it. Describe the turnoff, any gate or code, the driveway surface and whether there are dogs or livestock near the house. Gateway gives those notes to the partner clinician before the visit. A phone number that someone will answer on the day also helps if the clinician needs directions.

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.