Francesco Sforza (1401-1466) was primarily employed by Filippo Maria Visconti, duke of Milan, in the wars with Venice. In 1441, Francesco married Filippo's daughter Bianca Maria, acquiring the family name of Visconti which is present on this medal. Upon Filippo's death in 1447, Milan was briefly a republican government. After years of famine and following riots, the city's senate recognized Francesco as duke. An able ruler who modernized Milan, he died in March of 1466, and was succeeded by his son, Galeazzo Maria Sforza.

The style of the bust suggests that it is based on a painted portrait. Pollard notes that while Sperandio did appear on the ducal accounts compiled after Francesco's death, there is no proof that Sperandio ever visited Milan and the recorded sum is too large for a medal. He suggests that the medal was produced while Sperandio was in Ferrara.

The building on the reverse, in a Renaissance style and built on a Greek cross plan, is believed to be a design for a memorial chapel for the duke. It is probable that this medal was commissioned as a memorial to the duke following his death in 1466.