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Cankle /ˈkæŋkəl/– noun – the somewhat kitschy and slang term for oversized, swollen ankles that occur when and if the ankles thicken and the lower calf appears to merge with them. (C is for calf, get it?)

It may not seem like too big of a cosmetic concern – unless, of course, you have cankles. If you do, you are likely too self-conscious to sport ankle-strap sandals or skinny jeans, and even short shorts are a risk as they may draw attention to the area. And you can just forget all about ankle bracelets – anklets – should they ever come back into style.

We asked four top plastic surgeons to tell us more about the causes of this common aesthetic concern, and the procedures that can be performed to banish chunky ankles.

Cankles
Drs. Schulman, Devgan, Lorenc, and Higgins

What Causes Cankles?

Cankles is not a medical term or a medical condition, and there really is no golden calf-to-ankle ratio that we all aspire to. But “a nice transition between the calf and ankle gives a more pleasing appearance,” explains Matthew Schulman, MD, a board-certified plastic surgeon practicing in New York City.

There are a handful of possible causes of cankles. In some cases, it’s weight gain in the area. Other times it may be fluid retention during pregnancy, or due to kidney disease, excessive sodium intake, blood clots, or heart failure. Sometimes genetics has a hand in cankles too. (If your mom has cankles, you’re at risk.) Fluid retention in the ankles should be checked out by a doctor as it could be a sign of a more serious condition.

“The ankles are an area of the body that can be prone to fat deposition, depending on your genetic tendencies and body type,” says Lara Devgan, MD, a plastic surgeon in New York City and an attending plastic surgeon at Lenox Hill Hospital. “Most of the time, cankles are not related to obesity or being overweight. They are areas of fullness resistant to diet and exercise modifications in select individuals.”

The same can be said for love handles, under-the-bra fat, and even the dreaded double chin, but unfortunately there isn’t a perfectly sized applicator that allows surgeons to non-invasively freeze, melt, zap or inject away cankles – at least not yet.

Calf Augmentation

RELATED: Skipping Leg Day: A Simple Guide to Calf Augmentation

What Is Cankle Surgery?

There are, however, some fixes for cankles. “When the transition between the ankles and the calf is blunted, it can be the result of large ankles or small calves,” Dr. Schulman says. “If the calves are small, then the solution is calf enlargement, either through exercise, fat transfer, or calf implants,” he says. “If the ankles are too large, then the treatment will be directed at reduction of the area.”

Calf implant surgery involves crafting an incision in the natural crease line behind your knee, and inserting an implant within the calf muscle. Results are permanent, but risks may include infection, bleeding, scarring and implant shifting.

“My personal strategy for a patient with cankles is to focus on calf enlargement and contouring with fat transfer. I think this is the safest and most predictable treatment,” he says. Fat transfer involves taking fat from someplace where it is plentiful and implanting it where it is in short supply, ie, the calf area.

When it’s the ankles that are oversized, Dr. Devgan prefers micro-liposculpture. “By using fine tipped cannulae, a plastic surgeon is able to meticulously sculpt this anatomic area to make the entire lower leg appear slimmer and more defined. This is done by creating a more distinct junction between the calf and the ankles.”

“A fat inner ankle responds very well to liposuction,” agrees New York City plastic surgeon Z. Paul Lorenc, MD.

Dr. Schulman adds that lipo is no panacea. “More commonly, it is not fat, but rather the underlying bone structure that gives a large appearance making liposuction useless,” Schulman explains. “Also, some women have chronic swelling of the lower extremities and ankles because of venous or lymphatic insufficiency. This makes the ankles appear larger, but not because of excess fat.”

Liposuction can also be risky in this area due to the presence of a large number of blood vessels and nerves, he says. “Swelling in this area after liposuction can be significant and prolonged, lasting over nine months in my experience.”

“If the issue is swelling or edema due to varicose veins or poor circulation, then perhaps treating the veins with a vascular surgeon is a better option,” adds Las Vegas-based plastic surgeon Terrence Higgins, MD. “In the future, noninvasive treatments such as Kybella might prove to be options for treating fat in this area,” he suggests.

As of now, however, noninvasive treatment modalities are significantly less effective, Dr. Devgan says. “They are not able to precisely differentiate between fat depositions, tendons, arteries, veins, nerves, muscles, bone, and soft tissue, and this limits their utility.”

The bottom line is “this is a very difficult area to treat and should only be done by a board-certified plastic surgeon experienced in this particular area,” Schulman concludes.

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About The Author

Articles by

Denise Mann is a contributing health and beauty writer for Zwivel. She resides in New York City. Her work appears on WebMD, Everyday Health, CNN, HealthDay, Newsday and many other outlets. She was awarded the 2004 and 2011 journalistic Achievement Award from the American Society for Aesthetic Plastic Surgery.

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