Fast bowler Pat Cummins is almost certain to miss the rest of Australia's Test summer after being diagnosed with a bone stress injury in his foot. Cricket Australia's medical staff face a challenge in working out how best to handle Cummins, one of several fast bowlers currently sidelined, and the team physio Alex Kountouris conceded managing workloads was an area that needed improvement.

Cummins, 18, was a revelation during his Test debut in Johannesburg last month, where he took seven wickets, hit the winning runs and was Man of the Match. But it was during that game that he hurt his left heel, a problem that initially ruled him out of the series against New Zealand and now looks set to sideline him until mid-January.

The lack of Sheffield Shield cricket in January, when the Big Bash League takes centre stage, means Australia would be taking an enormous risk if they reintroduced Cummins into the Test side for the end of the series against India, which finishes in Adelaide in late January. Australia's physio, Alex Kountouris, said Cummins was unlikely to play any part in the India series.

"To play Test cricket he needs to be bowling a lot and the problem is now he is not going to be bowling for anything between four and six weeks depending on how he is going, so to get his workload back up and he hasn't got a lot of bowling under his belt in general," Kountouris said. "He hasn't got five years bowling under his belt like Mitchell Johnson, someone like him we could bring back quickly

"It is going to be hard to get him back up for the latter start of the Indian series. It depends when he starts bowling and that is going to be monitored week to week but I wouldn't imagine he is going to be bowling before the start of the new year."

Especially worrying for Australia is the way Cummins' body has handled the longer form of the game. The Wanderers Test was only his fourth first-class appearance and in his previous match, the Sheffield Shield final of 2010-11, he bowled 65 overs, including 48 in the first innings, and struggled over the next few months with a back problem.

"It is a concern because the last two first-class game's he's played in, which was the Shield final and this Test match, he has picked up an injury in both of them," Kountouris said. "We thought he had a very good preparation because he has been working at New South Wales in conjunction with us since June-July and building up his workloads, everything was very strategic.

"The injury he's got ... it's hard to know. I haven't seen a bowler get a stress fracture of the heel, I've seen them get a fat pad injury. It's hard to know what's caused it, we gave him the best preparation we thought we could give him but it still didn't go well.

"It's from his heel hitting the ground. There's a lot of things we've got to look at. Is it his foot biomechanics, is it bad luck, is it the hard wicket, is it the spikes, the shoe - they're things we're looking in to at the moment."

Cummins hurt his heel early in the Johannesburg Test but fought through the pain and had scans after the match that suggested a fat pad problem - a soft-tissue injury of the heel. However, further scans in Australia after he did not recover as expected showed what was believed to be the beginnings of a stress fracture.

Australia must now work out the best way to handle Cummins, the latest in a string of fast bowlers to suffer serious injuries. Mitchell Johnson is out for the summer due after having foot surgery, Ryan Harris is on the comeback trail from a hip complaint, Ben Cutting is out for a month with a side strain, and the allrounder Shane Watson has missed two Tests due to a hamstring tear picked up while bowling. It has raised the issue of bowler workload, but Kountouris said there was no clear answer to the debate.

"Workloads are an issue," he said. "I'm not sure if it's the be all and end all. Mitchell Johnson got injured batting, he just slipped in the foothole and hurt his toe, so whether that's a workload issue or not is debatable. Ryan Harris is a 32-year-old fast bowler who has played a lot of cricket in the past and we're managing little things here and there, so again I don't think workload is an issue with him.

"Most of the problems we have with workloads is they go up and down a lot, they can bowl four overs with Twenty20 cricket, they can go into Shield games and Test matches and it can be a problem. But that's for us to manage. We've got to get better at that. All these competitions, IPL, Champions League, Big Bash, Shield cricket, Ryobi Cup, they're all here to stay and we've got to get better at managing that."