Why diabetic foot care takes a team
Diabetic foot care coordination in St. Louis exists because a diabetic foot ulcer usually has several causes at once. Nerve damage hides injuries. Reduced blood flow slows repair. High blood sugar makes infection harder to fight, and the shape of the foot or the fit of a shoe keeps pressure on the same spot.
Each of those problems tends to belong to a different clinician. Gateway’s role is to keep them working from the same information, so the plan is less likely to stall over a missing record or an unscheduled appointment.
Who is usually involved
Not everyone needs every specialist. The treating clinician decides which are needed. A typical team may include:
- Wound care clinician. Assesses the wound, removes unhealthy tissue when appropriate, selects dressings and tracks progress.
- Podiatrist. Manages calluses, nails, foot structure and pressure relief, and performs foot procedures when needed.
- Primary care clinician. Manages blood sugar, blood pressure, kidney health and medications.
- Vascular specialist. Tests blood flow to the foot and treats blocked arteries.
- Footwear specialist. An orthotist or pedorthist who fits shoes, insoles and braces.
- Home health or facility nurses. Carry out dressing changes and watch the foot between visits.
What Gateway coordinates
Clinical decisions belong to the treating clinician. We handle the work that surrounds them:
- Taking the request and gathering records, including recent labs and vascular test results when they exist.
- Arranging visits with a partner clinician in your home or facility.
- Sending the clinician’s orders, referrals and visit notes to the other offices involved.
- Following up on referrals so that appointments are made and results come back.
- Helping with supply and equipment orders.
- Keeping you and your family informed about what happens next.
Circulation and vascular referral
A foot needs enough blood flow to heal, and diabetes often narrows the arteries in the lower leg and foot. If pulses are weak or a wound is not improving, the treating clinician may order a circulation test or refer you to a vascular specialist. Our guide on peripheral artery disease and foot wounds explains why this matters.
Gateway helps with vascular referral coordination, including sending records ahead and asking about transportation if getting there is a barrier.
Blood sugar and primary care
Wound care and diabetes care affect each other. An infection can push blood sugar up, and high blood sugar can slow healing. Each clinician needs to know what the other is seeing.
Gateway shares wound visit notes with your primary care office. If regular office visits are hard for you, ask about diabetes care at home with a partner primary care clinician. Our guide to wound care and blood sugar lists questions to bring to both clinicians.
Footwear and pressure relief
Many diabetic foot wounds sit where the foot bears weight or rubs against a shoe, so the plan usually includes pressure relief. The treating clinician or podiatrist decides on the device, and a footwear specialist may fit it. See our page on offloading for foot wounds for the options a clinician may consider.
Coordination at home and in facilities
At home, visits come to you, which means fewer trips on an injured foot. Gateway lines up the visit schedule with home health when an agency is involved.
In skilled nursing, assisted living and rehabilitation settings, Gateway shares the treating clinician’s orders with nursing and therapy staff. If the facility has a visiting podiatrist, we ask how to reach them so the two plans agree.
Foot changes to report right away
Call the treating clinician’s office if you notice:
- A new blister, crack, sore or dark spot on either foot
- Redness, warmth or swelling, even without pain
- Drainage on a sock or a new odor
- A wound that looks larger or deeper
- Fever, chills or blood sugar running higher than usual
A foot that turns cold, pale or blue, or redness that spreads quickly up the foot or leg, needs urgent medical care. For an emergency, call 911. Our guide to diabetic foot ulcer warning signs covers these changes in more detail.
How to start
Call 314-325-0126 or request care online. Patients and families can ask with or without a referral. On the phone, we will ask which clinicians you already see, so we can connect with them instead of starting over.
Common questions
I already have a podiatrist. Do I still need coordination?
You may. Many people have a podiatrist they trust and still struggle to keep wound visits, primary care, vascular testing and supplies in step. Gateway does not replace your podiatrist. We ask how they want to be involved, send them wound visit notes and arrange added care only as the treating clinicians direct.
Can Gateway help if I do not have a primary care clinician?
Yes. Tell us when you call. Gateway can help you look for one, including partner clinicians who offer in-home primary care. Availability is confirmed by location and care setting. Having primary care in place helps with blood sugar, medications and other conditions that affect the foot.
Is this only for people with an open foot ulcer?
Most requests involve an open wound, but not all. People with a recently closed ulcer, a new blister or callus that worries them, or a healing amputation site can also call. The treating clinician decides what care is appropriate. Gateway can also help point you toward podiatry or primary care when that is the better fit.
What should I gather before a diabetic foot wound visit?
Gather a current medication list, recent blood sugar readings, the names and phone numbers of your clinicians, and the shoes you wear most often. If you have had circulation tests, imaging or a recent hospital stay, mention it so records can be requested. Write down when the wound started and what has been tried so far.
Related pages
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.