The big defender - sidelined since the first game of the season at Newcastle in August with a knee injury - looked comfortable in central defence up against West Ham's lively front two of Wellington Paulista and Modibo Maiga.
In an open encounter, Paulista struck first for West Ham in the 15th minute before Kenny McEvoy equalised in the 38th minute.
The result means the team is nine points clear at the top of the Elite Group from Liverpool, who leapfrogged Manchester United into second after beating Arsenal at Anfield on Monday.
Nabil Bentaleb and Cristian Ceballos had half-chances before the Hammers opened the scoring at Upton Park.
George Moncur whipped a corner into the near post area and Paulista timed his run to perfection to glance home.
The pair almost repeated the trick five minutes later as Paulista connected again, this time more centrally, but Tom Carroll was ready on the post to head away.
We started to find our feet from there - Carroll fed in McEvoy, who couldn't pick out Shaq Coulthirst - but West Ham carved out the next chance as Maiga chipped to the far post for Paulista to hit a downward volley that Lawrence Vigouroux appeared to touch onto the crossbar.
Carroll went close from distance before linking up again with McEvoy, this time for the equaliser.
The midfielder picked the ball up in the inside left channel and threaded the perfect pass inside full-back Jordan Spence for McEvoy to race onto from the left into the box and the tricky winger made no mistake one-on-one.
We went through on goal again within seconds as Bentaleb picked out Coulthirst, but this time Larkins sped off his line to block. At the other end, the half ended with Vigouroux at full stretch to turn away Sebastian Lletget's curler.
Laste Dombaxe replaced Carroll at half-time and the Hammers created the first three chances of the second half, all to Blair Turgott, who missed the target twice and then forced a flying save from Vigouroux.
It was all Spurs from there. Ceballos fired just wide from distance and then Larkins produced the save of the match to tip over Bentaleb's header from Ceballos' corner.
Coulthirst glanced Ryan Fredericks' cross just wide, substitute Jack Munns went close and Larkins was there again to deny Ceballos from 25 yards.
The final chance of note fell to West Ham as Moncur sent in a deep corner that landed at substitute Dylan Tombides' feet at the far post, but Vigouroux was out and in his face before he had time to settle and made the block.
West Ham (4-1-3-2): Larkins; Spence, Potts, Ruddock, Shaw; Nasha (Bywater, 68); Turgott (Tombides, 84), Moncur, Lleget; Malga, Paulista. Unused subs: Driver, Baxter, Maguire.
Spurs (4-3-3): Vigouroux; Fredericks, Hall, Kaboul (Barthram, 61), Fryers; Bentaleb, Carroll (Dombaxe, 46), Veljkovic; Ceballos, Coulthirst, McEvoy (Munns, 73). Unused subs: Priestley, Gallifuoco.