I had trouble using InnoDB MySQL 5.0 on OS X because of a my.cnf settings issue. Listing the gotchas in case it helps anyone:
If InnoDB is disabled, check the error log (hostname.err, in the data directory). I had an empty setting which I changed:
innodb_data_file_path = ibdata1:10M:autoextend
Hope this helps someone. I was running a rails app and getting errors with my sessions table.