Donald Trump’s noticeably swollen ankles made their latest public appearance Tuesday as the president hosted Canadian Prime Minister Mark Carney in the Oval Office.

The 79-year-old president’s cankles were photographed bulging over the tops of his black dress shoes during the meeting, which failed to produce a trade deal between the two North American neighbors.

Trump, who revived his idea of annexing Canada as the 51st state during his speech to top U.S. military leaders last week, has walked on enlarged ankles for months, due to a condition common in seniors where blood pools in the legs.

The extent of the president’s swelling was hard to miss Tuesday as he sat next to Carney, 60, and Vice President JD Vance, 41, whose ankles looked dainty by comparison.

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