Is my hip quitting on me? (The clinic).

? I am a 46-year-old male runner with a recurring hip problem that has me concerned. For the last five or six years, I've run 25-30 miles a week. I weigh 180 lbs. and run a 48:00 10K and a 4:00:00 marathon. I've always walked with my feet pointing out and wear out my shoes on the outside heel. I've noticed in the last year or so that when the shoes wear down, I experience hip pain while walking. When I buy new shoes, the pain goes away. I replace my shoes after 150 miles. I never have pain while running, but I'm wondering if I'm accelerating the deterioration of my hip joint by running. I don't think it's an iliotibial band problem; stretching does not help the pain. What can I do to prevent further damage as I get older? I do not look forward to hip replacement and I love running so much I'd hate to give it up.

Ron Buchwald, Meriden, CT

It sounds like you're replacing your shoes at an appropriate level. It's good that there's no pain while running, but the recurring hip pain while walking demands that you get a good medical examination. Running does not cause arthritis, but if you have arthritis, it will certainly aggravate the problem. Get a good physical and structural examination. Your family doctor may then refer you to an orthopedic specialist.

Joe Cerimele, MD, Poland, OH

Your history of hip pain could have multiple causes. Occasionally, adolescent hip problems will begin to exhibit symptoms around the age of 35 or 40 and become progressive. Asymmetry of range of motion needs to be evaluated. An orthopedic surgeon would typically give you a physical for this kind of evaluation. The doctor might request an MRI of the affected hip. You could have a cartilage tear, misshapen femoral head or joint space, circulatory disorder of the hip, a partial slipped epiphysis, or some cystic lesion of the femoral head or neck.

If the examination doesn't find an anatomical abnormality, then an orthotic might be worth considering.

Paul A. Lunseth, MD, Tampa, FL